Medicare Provider Enrollment Changes

Last last week, the Centers for Medicare & Medicaid Services (CMS) issued a final rule for Medicare Advantage and Medicare Part D that includes provisions directly affecting physicians. Beginning June 1, 2015, in order to prescribe under Medicare Part D, physicians or eligible prescribers must be enrolled in Medicare or, for those who have opted out of the program, have a valid affidavit on file with their Medicare contactor. Medicare Part D sponsors must deny pharmacy claims for providers who do not meet this criteria. See the entire final rule here.

CMS also finalized a proposal allowing the agency to revoke the Medicare enrollment of a physician or eligible professional who has a practice of prescribing Part D drugs that is abusive, fails to meet Medicare requirements or represents a threat to the health and safety of Medicare beneficiaries. CMS states it only plans to exercise this new authority in very limited and exceptional circumstances. Action related to this new provision may begin as early as July 22, the effective date of the rule.

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