Download MEDICARE PART D UPDATE CMS has announced a delay in the

MEDICARE PART D UPDATE
CMS has announced a delay in the enforcement of Medicare opt in/opt out claim denial for
prescriptions until December 1st. June 1 remains the deadline for dentists to enroll but CMS indicated
that applications would still be processed after that date. It is unclear last minute applications will be
managed prior to the new December 1st deadline.
CMS has recognized one of ADA’s primary concerns – that the forms used to enroll either as a Medicare
provider (CMS Form 855l) or as an Ordering and Referring Provider (CMS Form 8550) create problems
for dentists because there is not a dental enrollment category that dentists intuitively identify as
appropriate for their practice. Currently, the two categories listed are “Maxillofacial Surgery” and “Oral
Surgery (dentist only).” Most general dentists and many specialists do not identify with these terms. A
third option is the “Undefined physician type” which requires the dentist to specify a specialty. To date,
at least a few Medicare contractors have rejected applications because they do not recognize the dental
specialties or have rejected applications submitted by dentists.
Further instructions will be issued so that dentists with either a DDS or DMD degree are eligible to
enroll either as a Medicare Provider or as an Ordering and Referring Provider irrespective of the
physician type indicated. Furthermore, Modifications to the forms are planned to include a more
general category such as “Dentist” to the list. Because this modification will take time, CMS wants to
encourage dentists to enroll using the current form and select the “Maxillofacial Surgery,” “Oral Surgery
(dentist only)” or “Undefined physician type” category as appropriate. CMS will ask the Contractors to
review the applications that were previously denied in light of these new instructions.
CMS has not yet determined how a pharmacy will respond if, after the December 1 effective date, a
patient presents a prescription from a doctor who has not enrolled or opted out.
Watch for more news from ADA and NYSDA.