CMS-855O Medicare Enrollment Application
The CMS-855O Medicare Enrollment Application is a form used to enroll in Medicare as an individual or group practice opting out of the Medicare program.
The form consists of several parts, including general information about the applicant, information about the individual or group practice, and certification statements. The most important fields in the form include the applicant's name, contact information, and National Provider Identifier (NPI) number, as well as information about the group practice, if applicable.
This form is typically compiled by healthcare providers who have chosen to opt out of Medicare, meaning they will not bill Medicare for any services provided to Medicare beneficiaries. The parties involved in this document are the healthcare provider or group practice and the Centers for Medicare & Medicaid Services (CMS).
When compiling this form, it is important to ensure that all information provided is accurate and up-to-date. The applicant should also carefully review and agree to all certification statements included in the form.
The advantages of this form include the ability for healthcare providers to opt out of the Medicare program, allowing them to set their own fees and billing arrangements. However, problems can arise when filling out the form if the information provided is inaccurate or incomplete, which can result in delays or rejection of the application.
Related forms include the CMS-855I Medicare Enrollment Application for individual providers, the CMS-855B Medicare Enrollment Application for group practices, and the CMS-855R Medicare Enrollment Application for reassignment of benefits. Alternative forms include the CMS-855A for institutional providers. The main difference between these forms is the type of provider they are intended for.
The CMS-855O form can be submitted online through the CMS website or by mail to the Medicare Administrative Contractor (MAC) for the provider's state. The form should be stored in a secure location to ensure confidentiality of the information provided.