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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 Part B?
  • I provide Medicare Part B covered items and services. How do I enroll in Medicare?
  • How do I opt out of Medicare?
  • I don't provide Medicare Part B covered items or services, but I do order covered imaging, clinical laboratory, and DMEPOS. 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 to order covered imaging services, clinical laboratory services, and DMEPOS?
  • 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, or DMEPOS?
  • 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 the last 13 months. Does this apply to dentists?

Disclaimer

These materials are intended to provide helpful information to dentists and dental team members. They are in no way a substitute for actual professional advice based upon your unique facts and circumstances. This content is not intended or offered, nor should it be taken, as legal or other professional advice. The ADA makes no representation or warranty about the completeness, accuracy, or any other quality of information in this piece. You should always consult with your own processional advisors (e.g. attorney, accountant, insurance carrier). To the extent ADA has included links to any third party web site(s), ADA intends no endorsement of their content and implies no affiliation with the organizations that provide their content. Further, ADA makes no representation or warranties about the information provided on those sites.

© 2012-2020 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 February 6, 2020