Hospice Physicians/NPs: Do You Prescribe Part D-covered Meds?
September 30, 2015 01:15 PM
Over the last several months, NAHC Report has published informationregarding a new Centers for Medicare & Medicaid Services (CMS) requirement that all prescribers of prescription medications that will be processed through the Part D program must be enrolled in Medicare in an approved status. The requirement was scheduled to be applicable on June 1, 2015, but this date was delayed until January 1, 2016. In a recent notice, CMS further postponed the requirement, which will now become applicable on June 1, 2016.
However, if you are a hospice physician/NP that prescribes medications that are processed through Part D (these prescriptions would be for conditions that are NOT related to the terminal or related conditions) and you are NOT enrolled in Medicare in an approved status, action should be taken before the end of 2015 to ensure sufficient time for processing of your enrollment so that your patients will not run into Part D processing issues when enforcement of the requirement begins on June 1, 2016.
Following is information related to this issue that has been posted on the CMS Medicare Part D Prescriber webpage, along with additional resources:
Part D Prescriber Enrollment - About
If you're a physician or other eligible professional who writes prescriptions for Part D drugs, CMS regulations now require you to be enrolled in Medicare in an approved status.
The effective date for this requirement is June 1, 2016. To allow Medicare Administrative Contractors (MACs) that process the applications enough time to enroll all prescribers and to ensure prescriptions are not denied,it is strongly recommended that prescribers of Part D drugs enroll by January 1, 2016.
What happens if I don't enroll?
Federal regulation requires all physicians and other eligible professionals who prescribe Part D drugs to be validly enrolled* in the Medicare program. Part D plans will deny a pharmacy claim at point of sale for drugs prescribed by physicians or other eligible professionals who are neither enrolled in Medicare.* Enforcement of this provision is scheduled to begin on June 1, 2016; therefore, all prescribers should enroll by January 1, 2016, to allow for the processing of applications and to make sure enrollees get their prescriptions.
You can check your enrollment status using our online Enrollment File. Here are the instructions for using the file to check enrollment.
* Physicians and other eligible professionals, except for prescribers for Medicare Advantage organizations, may validly opt out of Medicare.