Stay Current And Compliant – Plan for New CMS Ruling
Monday, November 28th, 2011
This year, the Centers for Medicare and Medicaid Services released its 2012 Final Rule regarding prescriber identification number validation on Medicare Part D drug claims. In it, the CMS raises concerns regarding the large number of invalid prescriber identification numbers and the possibility of prescription fraud and drug abuse.
In response, the CMS is now requiring Medicaid Part D sponsors to confirm the validity of Drug Enforcement Administration numbers on drugs listed in schedules II through V or map National Provider Identifier numbers to the prescriber’s DEA number. It also requires that sponsors confirm that the controlled substance is within the prescriber’s scope of practice to prescribe and that all identifiers are valid and active.
While the Final Rule allows for pharmacies to create their own verification system using DEA registrant files, the Social Security Administration death file, OIG and Medicaid program excluded provider lists, and the CMS National Plan & Provider Enumeration System database, it also allows for the contracting of third-party vendors to supply prescriber information and facilitate the validation process.
While the choice is left up to pharmacies as to how they meet these requirements, for many larger pharmacies, contracting with a third-party vendor will make the most sense as the number of claims these large pharmacies process coupled with the numerous databases that must be checked and maintained make creating an internal system of DEA and NPI validation inconvenient and cumbersome.
Pharmacies looking for a third-party validation partner to provide up-to-date prescriber data have been choosing Healthcare Data Solutions’ prescriber validation services. HDS’ comprehensive prescriber validation databases update DEA and NPI numbers to provide the most current and accurate prescriber validation information available, assuring pharmacies a dependable partner in Medicare Part D claims compliance.
Contact Healthcare Data Solutions today to learn more about how HDS products and services can assist with Part D compliance.