CMS-855B Medicare Enrollment Application

The CMS-855B is a Medicare Enrollment Application for clinics, group practices, and certain other suppliers who wish to enroll in Medicare. This form is used when a new organization is applying for Medicare enrollment, or when an existing organization is making changes to their enrollment information.

The CMS-855B consists of several parts, including:

• Provider Information: This section includes general information about the provider, such as their name, address, and contact information.
• Practice Location Information: This section includes information about the practice location, including the address and phone number.
• Business Information: This section includes information about the business structure, such as the legal name and tax ID number.
• Reassignment of Medicare Benefits: This section is used to indicate that the provider is reassigning their Medicare benefits to a group or an organization.
• Electronic Funds Transfer (EFT) Information: This section is used to provide banking information for electronic payment of Medicare services.
• Ownership and Control Information: This section is used to provide information about the ownership and control of the organization.
• Signature and Certification: This section is used to certify that the information provided on the form is accurate and complete.

The most important fields on the CMS-855B are the provider's name, address, and contact information, as well as the business information and ownership and control information.

This form is compiled when a new organization is applying for Medicare enrollment, or when an existing organization is making changes to their enrollment information. The parties involved in this document are the organization applying for Medicare enrollment and the Centers for Medicare & Medicaid Services (CMS).

When compiling the CMS-855B, it is important to ensure that all information provided is accurate and complete. Failure to provide accurate information can result in delays in processing the application or even rejection of the application.

The advantages of the CMS-855B form include the ability for clinics, group practices, and certain other suppliers to enroll in Medicare and receive reimbursement for their services.

One potential problem when filling out the CMS-855B form is ensuring that all information provided is accurate and complete. This can be a time-consuming process, and errors can result in delays or rejection of the application.

Related forms to the CMS-855B include the CMS-855I (Medicare Enrollment Application for Physicians and Non-Physician Practitioners), CMS-855R (Medicare Enrollment Application for Physicians and Non-Physician Practitioners Reassigning Medicare Benefits), and CMS-855A (Medicare Enrollment Application for Institutional Providers). These forms are used for different types of Medicare enrollment.

The CMS-855B form can be submitted electronically through the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) or by mail to the appropriate Medicare Administrative Contractor (MAC). Completed forms are stored in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) and can be accessed by authorized Medicare staff.