So what is the big deal.  If you don’t have a relationship with Medicare you will need to establish one or your Medicare patients will be running from your practice! Why- because if you do nothing and you give your Medicare patient a prescription they will have to pay for those prescriptions out of pocket.

This issue stems from your relationship with Medicare part B. Medicare part B is the part of Medicare that provides payment to the providers. The CMS as of June 1, 2015 is requiring that you Opt In or Opt Out of Medicare part B.  If you do not take either of those active steps your patients with Medicare will not be able to have Medicare pay for the drugs you prescribe them under their Medicare part D.

But you don’t want Medicare to know anything about you and your business and don’t bill to Medicare. Remember the NPI number that you are using? Well Medicare knows all about you so not enrolling will not keep your existance a secret.

So here is the deal.  There are three other options;

  • Opt Out
  • Opt In as an ordering/referring provider
  • Opt In as a Medicare provider

If you Opt Out you will be required to explain this to each of your Medicare customers and enter into a private contract with those patients.  I call this the HIPAA notice light option.  This will involve making sure you have these contracts with your Medicare patients done and kept up to date. You will also be required to file an affidavit with your CMS contractor for Jurisdiction L if you practice in Pennsylvania.

  • Opt In for prescription and ordering tests should be given serious consideration. This will be done through the PECOS website and requires the use of form 855O.
  • Opt In as a Medicare provider is an option but if you are not going to be doing any medical cross coding submissions with your Medicare patients it probably doesn’t make sense.This will be done through the PECOS website and requires the use of 855I.

The deadline for this new requirement is June 1, 2015 and keep in mind that the process can take from 45 to 60 days. The Enrollment Application page is very helpful. #Dentist&Medicare

This document is intended to provide information of general interest and is not intended to offer legal advice about specific situations. The author does not intend to create an attorney-client relationship by offering this information, and anyone’s review of the information shall not be deemed to create such a relationship. You should consult a lawyer if you have legal matters requiring attention.