If an independent pharmacy is already accredited to bill Medicare Part D, the process to gain accreditation for Medicare Part B still requires a few additional steps. Here’s a breakdown of the process, keeping in mind the pharmacy’s existing Medicare Part D accreditation:

Steps to Add Medicare Part B Billing (When Already Billing Part D)

1. Verify Existing Enrollment and Update via PECOS: Since your pharmacy is already accredited for Medicare Part D, you should have an account in PECOS (Provider Enrollment, Chain, and Ownership System). 

You’ll need to update your enrollment information in PECOS to include Medicare Part B billing. This involves adding the appropriate supplier type (such as DMEPOS supplier, if relevant) and any other services you plan to bill under Part B.

2. Obtain DMEPOS Accreditation (if applicable): If your pharmacy plans to bill for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) under Medicare Part B, you’ll need to obtain a DMEPOS accreditation. Even if you are accredited for Medicare Part D, this additional accreditation is necessary for DMEPOS.

Choose a CMS-approved accrediting organization, and undergo the DMEPOS accreditation process, which may include:

If your pharmacy doesn’t plan to provide DMEPOS and only wants to bill for services like vaccines, this step might not be necessary.

3. Acquire a Surety Bond (if applicable): Pharmacies intending to bill for DMEPOS under Medicare Part B must obtain a $50,000 surety bond. This is required even if you are already accredited to bill Part D.

If you are not providing DMEPOS, this step is not required.

4. Comply with Medicare Part B-Specific Rules: Even though your pharmacy already complies with Medicare Part D rules, there are additional specific regulations for billing under Part B:

Ensure you comply with Medicare Part B billing requirements for any services or items your pharmacy will provide (e.g., vaccines, diabetic supplies, or DMEPOS).

Review Medicare guidelines on claims submission, reimbursement, and documentation specific to Part B.

5. Enroll in Medicare Part B Immunization Program (if applicable): If your pharmacy intends to bill Medicare Part B for vaccinations (e.g., flu, pneumonia), you can enroll in Medicare Part B without needing DMEPOS accreditation.

Follow the Medicare Immunization Enrollment Process to gain privileges for billing vaccines to Part B.

6. Review HIPAA and State Compliance: Ensure your pharmacy continues to comply with HIPAA requirements and any additional state-level requirements for billing Medicare Part B services.

Make sure to review documentation and privacy practices to account for the new services or products you plan to provide under Part B.

7. Submit Final Updates and Receive Approval: Once you’ve completed the necessary steps (DMEPOS accreditation, surety bond if applicable, and PECOS enrollment update), submit all final documentation through PECOS for review.

After approval, you will receive confirmation from Medicare that your pharmacy is authorized to bill for Part B services.

Summary of Differences Between Part D and Part B

Part D: Covers prescription drugs (including those the pharmacy dispenses), usually involves working with prescription drug plans (PDPs).

Part B: Covers certain medical supplies, vaccines, and DMEPOS. Requires additional accreditation (DMEPOS) if you’re providing durable medical equipment or supplies.

Even if your pharmacy is already billing under Part D, you must complete the necessary steps for Medicare Part B due to the differences in services and billing regulations. However, your existing PECOS enrollment can make the process faster since some