New Medicare Part D rules - also covers DME

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VikingGnome
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New Medicare Part D rules - also covers DME

Post by VikingGnome » Wed Sep 17, 2014 9:32 pm

Got my annual book about my Medicare Part D Prescription coverage rules for next year. New rule. For your prescriptions to be covered by Part D, the physician that wrote the prescription must (1) be a participating provider with Medicare OR (2) file proof with DMS that the provider writing the prescription is legally allowed to write prescriptions. So just because the state dictates who is allowed to write prescriptions is no longer acceptable. The almighty federal government wants proof above and beyond what state license board tells pharmacies is legal. They are going to demand proof directly from providers that they are licensed to write prescriptions for Medicare Part D to cover the item.

OMG. More paperwork. Most of my providers are participating providers with Medicare but I have two that terminated all Medicare patients within the past year. Both I have had 12 year relationships with so hate to start all over with new providers for those issues. So if they write a prescription for me, Medicare Part D won't cover it unless proper paperwork is filed with DMS. My Doctors aren't going to mess with Medicare paperwork. They've washed their hands of Medicare altogether. Medicare has just gone TOO FAR. What possible purpose could this extra paperwork accomplish but deny prescription coverage to patients that get scripts from nonparticipating providers. This is just plain WRONG.

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Last edited by VikingGnome on Thu Sep 18, 2014 9:00 am, edited 1 time in total.

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Denial Dave
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Re: New Medicare Part D rules

Post by Denial Dave » Thu Sep 18, 2014 5:42 am

I certainly appreciate the need to have a licensed doctor that is authorized to issue prescriptions.

it's much better than the alternative of having some stranger on the corner or an untrained cashier handling it.

Want fries with that CPAP mask prescription?


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VikingGnome
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(CMS-4159-F) also includes DME not just prescription drugs

Post by VikingGnome » Thu Sep 18, 2014 8:52 am

Here is the actual text of the new rule (Obamacare strikes again).

(CMS-4159-F) Require that prescribers of Part D drugs enroll in Medicare: Section 6405 of the Affordable Care Act requires that physicians and eligible professionals who order durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) or certify home health care for beneficiaries be enrolled in Medicare. The statute also permits the Secretary to extend these Medicare enrollment requirements to physicians and eligible professionals who order or certify all other categories of Medicare items or services, including covered Part D drugs. Accordingly, CMS will require that physicians and eligible professionals who write prescriptions for covered Part D drugs must be enrolled in Medicare, or have a valid record of opting out of Medicare for their prescriptions to be covered under Part D. This requirement will help CMS ensure that Part D drugs are only prescribed by qualified individuals. This provision is effective June 1, 2015.

So you think the Medicare bureaucracy is better prepared to keep track of which care providers care are currently licensed by each state than the state itself? Really? And any provider that refuses to be part of the Medicare circus is incompetent to practice medicine. That's what this rule essentially says. Unless nonparticipating providers file an "opt out" form with Medicare, ANYTHING they prescribe won't be covered under Part B or D. Not DME, not home health care, not drugs, not physical therapy or occupational therapy.

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Demerit

Re: New Medicare Part D rules - also covers DME

Post by Demerit » Thu Sep 18, 2014 6:09 pm

This has been in effect since 1.6.2014. Medical providers need to be Pecos registered in order to receive Medicare reimbursement. If the ordering dr is not Pecos registered, the dme doesn't get paid. Same with sleep studies, a psg needs to be read and signed by a board certified sleep physician or the lab needs to accredited.

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VikingGnome
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Joined: Fri Feb 03, 2012 6:46 pm
Location: Mississippi

Re: New Medicare Part D rules - also covers DME

Post by VikingGnome » Thu Sep 18, 2014 6:11 pm

May have been voted into a rule but does not go into effect until June 2015. I had a prescription filled just last week that was prescribed by a nonparticipating provider.

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Additional Comments: Pressure Setting 22/18; Pregnancy pillow to keep me sleeping on side