CMS-855S Medicare Enrollment Application

The CMS-855S is a Medicare Enrollment Application used by suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) to enroll in the Medicare program or make changes to an existing enrollment record. The form is used to ensure that suppliers meet Medicare's enrollment requirements and are qualified to provide DMEPOS to Medicare beneficiaries.

The CMS-855S form consists of several parts, including:

1. Provider/Supplier Identification Information
2. Practice Location Information
3. Business Organization Information
4. Provider/Supplier Agreement to Accept Assignment
5. Supplier Ownership and Control Information
6. Authorized Official Information
7. Disclosure of Ownership and Control Information
8. Financial Information
9. DMEPOS Information
10. Additional Information

The most important fields on the CMS-855S form include the provider or supplier's legal business name, National Provider Identifier (NPI) number, tax identification number, contact information, and DMEPOS information such as the types of products and services offered.

The CMS-855S form is typically compiled by suppliers of DMEPOS who wish to enroll in the Medicare program or make changes to an existing enrollment record. The parties to the document are the supplier and the Centers for Medicare & Medicaid Services (CMS).

When compiling the CMS-855S form, it's important to ensure that all information provided is accurate and up-to-date. This includes verifying that the supplier meets Medicare's enrollment requirements and is qualified to provide DMEPOS to Medicare beneficiaries.

One advantage of the CMS-855S form is that it provides a streamlined process for suppliers of DMEPOS to enroll in the Medicare program or make changes to an existing enrollment record. However, problems can arise when filling out the form if the information provided is inaccurate or incomplete. This can result in delays or denials of enrollment.

Related forms to the CMS-855S include the CMS-855A, which is used by physicians and non-physician practitioners to enroll in the Medicare program, and the CMS-855B, which is used by clinics, group practices, and certain other suppliers to enroll in the Medicare program.

An alternative form to the CMS-855S is the electronic Medicare Provider Enrollment, Chain, and Ownership System (PECOS) application, which allows providers and suppliers to enroll in the Medicare program or make changes to an existing enrollment record online.

The CMS-855S form can be submitted electronically through PECOS or by mail to the Medicare Administrative Contractor (MAC) in the supplier's state. The completed form is stored in the supplier's enrollment record with CMS.