ALERT! NON-PAR MEDICAID AND
MEDICARE PROVIDERS FACE
RESTRICTIONS
New changes regarding Medicaid and Medicare enrollment have
restricted providers who aren’t signed on to these services.
Because of regulations mandated by the Affordable Care Act, the
Kentucky Department for Medicaid Services (DMS) requires all providers that prescribe medication, order a service, or refer a Medicaid
recipient be enrolled as a curren t Medicaid provider in order for these
services to be reimbursed. Without an active Medicaid ID number,
there would be no reimbursement for prescriptions by non-Medicaid
providers and prescriptions would be denied to patients.
This amended regulation became effective March 6, 2015 and
managed care organizations are now truly enforcing this law.
Some providers may not submit claims for reimbursement of any
services provided but are now required to enroll solely for purposes
of ordering and referring services for Medicaid beneficiaries. If you
are not a Medicaid provider, you may want to notify your patients
that if they accept a prescription from a non-Medicaid provider, DMS
will not pay for the prescription.
Regarding Medicare, the Centers for Medicare & Medicaid Services
(CMS) recently finalized CMS-4159-F, a rule requiring physicians
and other eligible professionals who write prescriptions for Part D
drugs to be enrolled in the Medicare Provider Enrollment, Chain,
and Ownership System (PECOS) in an approved status OR have a
valid opt-out affidavit on file for their prescriptions to be covered.
The date of CMS enforcement is December 1, 2015.
Prescribers should submit their Medicare enrollment applications
or opt-out affidavits to their Medicare Administrative Contractors
by June 1, 2015 or earlier to ensure that MACs have sufficient time
to process the applications or opt-out affidavits and avoid their
patients’ prescription drug claims from being denied by their Part
D plans beginning December 1.
For more information about the change in Medicaid requirements,
contact the GLMS Physician Education & Practice Support Department at 502-736-6354 or [email protected].
Amadeo L. Abraham, M.D
Zaka U. Khan, M.D.
M. Lynell Chamberlain, M.D.
J. Wesley McConnell, M.D.
Sonia Vishin Compton, M.D.
Josephine Mei, M.D.
Rahel Teferra, M.D.
The physicians of Kentuckiana Pulmonary Associates
are excited to announce that
Muhammad Yasin, M.D.
will be joining our practice
Effective July 2015
Accepting new patients
587-8000
Residency & Fellowship Programs
Interfaith Medical Center
Internal Medicine
University of Florida
Geriatric Fellowship
University of Louisville
Pulmonary-Critical Care Medicine Fellowship
Specialist in
Pulmonary, Critical Care and
Geriatric Medicine
www.kpadocs.com
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GLMS NEWS MAY 2015