The Centers for Medicare and Medicaid Services (“CMS”) has issued newly revised Medicare enrollment forms for all provider and supplier types. The new forms became effective July 1, 2011, and are available on the CMS website. Notable revisions to the forms include the following:

CMS 855A

The revised CMS 855A form has broad new instructions regarding the reporting of ownership and managing control interests. Specifically, the updated form contains new instructions regarding when to report mortgages and security interests in the provider or its assets, as well as a clarification that some limited partnership interests in the provider need not be reported. The updated instructions regarding reporting of ownership and investment interests in the CMS 855A were not added to the other CMS 855 enrollment forms.

Additionally, the updated CMS 855A now requires the following information: identification of the existence of a hospital’s compliance plan, identification of whether the hospital is physician-owned, and identification of the provider as proprietary or nonprofit.

CMS 855B, 855S, 855I

The CMS 855B, 855S, and 855I now require the following information:

  • Identification of the supplier as proprietary or nonprofit.
  • Reporting of accreditation for independent diagnostic testing facility suppliers that will bill the Medicare program for advanced diagnostic imaging services.
  • Place and country of birth for individuals that have an ownership or managing control interest in the supplier.

CMS removed the enrollment distinction in the form CMS 855B between single specialty and multi-specialty medical groups.

CMS 855O

The CMS 855O is a brand new enrollment form which is meant for those physicians and non-physician practitioners enrolling in Medicare for the sole purpose of ordering or referring items or services for Medicare beneficiaries. These physicians and non-physician practitioners do not and will not send claims to a Medicare contractor for the services they furnish.