Credentialing Corner

# What Does DEA Registration Mean For Medical Billing Professionals?

- May 27, 2024
- Posted by Kristen Edwards

12 Mar

Having a cornerstone role in the drug control of the United States, the Drug Enforcement Administration (DEA) keeps the public safe and healthy by regulating controlled substances like Opioids and narcotics. These types of substances, like, for example, prescription drugs and illicit drugs, have the potential to be used in a harmful manner and to develop an addiction. The DEA’s mission is to keep the diversion of these substances to illicit networks from proper medical use.

DEA registration is a legal step of medical credentialing for healthcare providers dealing with these controlled substances to be authorized and trained to do this safely and responsibly. This is a legal issue that is in place for this important reason. This article will explain the importance of DEA registration, its impact on medical billing professionals, and the mandatory steps to get the registration done.

## What does DEA mean?

DEA registration stands for a specific number of healthcare providers such as physicians, dentists, CNs, and pharmacists who have the authority to prescribe and handle controlled medicines but under various conditions and terms received. It is a legal requirement termed the Controlled Substance Act (CSA) that is being implemented by the Drug Enforcement Administration (DEA).

## Types of DEA Registration

There are several types of DEA registrations, including:

- Practitioner Registration: Among the most commonly affected groups in this context are healthcare providers who further ensure that the controlled substances are appropriately prescribed, dispensed, or administered to their patients.
- Hospital/Clinic Registration: To meet the needs of hospitals, clinics, or other healthcare entities dealing with controlled drugs.
- Mid-Level Practitioner Registration: Nurse practitioners, physician assistants, and other mid-level health care providers can issue narcotics prescriptions to their patients only under the guidance of a licensed physician.
- Researcher Registration: In the case of the researchers who go ahead with the controlled drugs as per the laws.
- Manufacturer/Distributor Registration: For commercial and wholesale distributors operating in radiopharmaceuticals, narcotics, and contraceptives.

## How DEA Registration Affects Medical Billing Professionals

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### Billing for controlled substances

DEA certificate helps medical billing specialists to bill controlled substances. Healthcare professionals must get DEA registration and the authority to reimburse controlled substance prescription bills to insurance companies. Prescriptions for controlled substances must also be in line with insurance company rules. The medical billing professionals here must ensure healthcare providers submit claims compliantly with this requirement.

### Compliance with Regulations

In medical credentialing, DEA registration ensures that healthcare providers will comply with federal and state laws governing the prescription and dispensing of controlled substances (CS). Medical billing professionals responsible for handling-controlled substance prescriptions need to guarantee that healthcare providers maintain accurate records and claims for such prescriptions, including all the requirements outlined by the insurance companies.

### Handling of Prescriptions

DEA registration impacts the work of medical billing professionals significantly because they can not handle cases with controlled substance prescriptions. Clinical staff must be registered with DEA, and as a result, their ability to issue controlled substances to the patients is granted. Medical billing professionals should check if the physicians’ prescriptions for drugs regulated by the state and federal government align with these regulations.

### Impact on Reimbursement

DEA certification or registration would make medical billers who work with controlled drug prescriptions meet the criteria for reimbursement. Insurers can inquire about the registry number of healthcare providers and pay compensation for controlled substance prescriptions only after receipt. It is the responsibility of medical billing personnel to get assurance from healthcare providers that they have a valid DEA registration number and check whether their claim forms conform to the insurance company’s requirements about controlled substance prescriptions.

## How to Become a DEA Registered Drug Manufacturer

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### 1. Eligibility Criteria

To obtain a DEA registration, healthcare providers must meet specific eligibility criteria. The first item is possessing a valid, in-state medical license. Aside from the application form, payment is also essential to this process. You are showing the record clean and providing the fingerprints. Supporting proof is required, which includes education and training in prescribing and handling controlled substances.

### 2. Application Process

The registration process with the DEA consists of several stages: a form completion, paying a fee, and undertaking a criminal record check. You must find out the details of the law and be ready to face a somewhat long approval process.

### 3. Renewal and Maintenance

Enlisting the waiver for DEA registration must be a vital process for healthcare providers that would make it possible for them to handle controlled substances. The healthcare providers will renew their DEA registrations by way of completion of a renewal medical credentialing application made together with appropriate fee payment.

At the same time, they must show continual education on the controlled substances list, which has also become their primary task. Therefore, they will also need to go through a criminal history record check and scan their two thumbs for comparison purposes.

Ultimately, they will need to wait for the DEA’s permission, which can take anywhere from one month to many months. This step-by-step procedure guide will enable healthcare providers to maintain registration and provide their respective prescriptive and controlled substances care.

## Importance of DEA registration in medical billing practitioners

### Legal Compliance

DEA registration is a formal requirement for medical billers who work with healthcare providers and non-illicit drug dispensers or in the prescription of controlled substances. Hence, it safeguards that healthcare providers are authorized to administer controlled substances and keep up with the requirements of both federal and state regulations. The inability to obtain a DEA registration may lead to legal consequences such as penalties, suspension of health care practices, and criminal charges.

### Patient Safety

DEA registration can prevent the working drugs or substances controlled from being abused or used in the wrong ways that cause severe damage to patients and public health. While bearing the responsibility of the healthcare providers’ enforcement of the DEA regulations and keeping accurate records on the decline of controlled substance prescriptions, medical billing specialists are one of the key stakeholders in the industry.

### Insurance Reimbursement

DEA registration has become a common practice for healthcare providers who bill insurance to get payment for their controlled substance prescriptions. Insurance companies might need a DEA license approval certificate for cases of prescribing controlled substances. Medical billers are responsible for checking for valid DEA registration codes of healthcare providers, and insurance companies need the claims for controlled substances prescriptions to comply with their coverage rules.

### Prescribing Controlled Substances

Medical professionals, to be allowed to prescribe controlled substances to patients, must be registered with the DEA. Compliance with DEA and state and federal regulations is the primary duty of medical billing professionals, who must ensure that healthcare providers have valid DEA registrations and prescription guidelines meet them.

## Conclusion

The DEA registration process is the legal authorization step in medical credentialing of the healthcare system. The professional should undergo education and training in administering and controlling controlled substances to facilitate the activity as a practitioner of controlled substances. Medical billing workers are of immense importance to healthcare providers to keep track of the prescription accuracy of controlled drugs and ensure they get their healthcare services in conformity with DEA (the Drug Enforcement Administration) rules and regulations.

They not only must make sure that physicians’ claims for controlled substance prescriptions are according to insurance company guidelines, but they should also conduct audits, which help create a projection for losses.

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