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Medicare Enrollment FAQ

  • Do I need to either enroll in Medicare or formally opt out?
  • If I opt out of Medicare, can I continue to receive payment for services to Medicare beneficiaries under a Medicare Advantage plan?
  • How can I find out which dental items and services are covered by Medicare?
  • I provide Medicare covered items and services. How do I enroll in Medicare?
  • How do I opt out of Medicare?
  • I don't provide Medicare covered items or services, but I do order covered imaging, clinical laboratory, DMEPOS and prescribe drugs for patients with Medicare Part D prescription drug plans. How do I enroll?
  • What is "PECOS"?
  • I enrolled in Medicare using Form CMS-855-I, but I don't provide Medicare covered services. Do I need to re-enroll using Form CMS-855-O in order to order covered imaging services, clinical laboratory services, and DMEPOS, or to prescribe drugs for patients with Medicare Part D prescription drug plans?
  • I'm not sure whether I'm enrolled in Medicare. Is there a way to check?
  • What if I enroll in Medicare using CMS-855-O, but later wish to enroll to be reimbursed by Medicare?
  • What happens if someone who isn't enrolled or opted out orders covered imaging services, clinical laboratory services, DMEPOS, or prescribes Medicare Part D drugs?
  • I bill Medicare for imaging services, clinical laboratory services, or DMEPOS. What do I need to do?
  • Which NPI needs to be on the claim: Type I or Type II?
  • How long will it take for my CMS-855-O to be processed?
  • What if the information on my enrollment application changes?
  • What are the recordkeeping requirements for dentists who order covered clinical laboratory services, imaging services, or DMEPOS?
  • What about orders from residents?
  • What is the purpose of this regulation?
  • How can I protect my information in PECOS from identity thieves and persons who want to commit fraud?
  • I’ve heard that CMS will use site visits as a screening activity to make sure only qualified providers and suppliers are enrolled. If I enroll in Medicare, could I be subject to a site visit?
  • CMS will deactivate the enrollment of providers who have not billed Medicare in teh last 13 months. Does this apply to dentists?

 Legal Disclaimer
The foregoing was prepared by the ADA Division of Legal Affairs. Its purpose is to promote awareness of legal issues that may affect dentists and dental practices. This document is not intended to provide either legal or professional advice, and cannot address every federal, state, and local law that could affect a dentist or dental practice. Because the law varies from jurisdiction to jurisdiction, and sometimes changes more rapidly than these materials, we make no representations or warranties of any kind about the completeness, accuracy, or any other quality of the information in the above piece. Nothing here represents advice or opinion as to any particular situation you may be facing; for that, it is necessary to consult directly with a properly qualified professional or with an attorney admitted to practice in your jurisdiction for appropriate legal or professional advice.  To the extent the above includes links to any websites, the ADA intends no endorsement of their content and implies no affiliation with the organizations that provide their content. Nor does the ADA make any representations or warranties about the information provided on those sites, which we do not control in any way.

© 2012, 2013, 2014, 2015, 2016 American Dental Association. All rights reserved. Reproduction of this material by member dentists and their staff for use in the dental office is permitted. Any other use, duplication or distribution by any other party requires the prior written approval of the American Dental Association.

Revised October 31, 2016