Medicare Registration Application (CMS-855O)

ICR 201603-0938-020

OMB: 0938-1135

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Form and Instruction
Modified
Form and Instruction
Modified
Supplementary Document
2012-06-22
Supporting Statement A
2016-03-28
ICR Details
0938-1135 201603-0938-020
Historical Inactive 201206-0938-005
HHS/CMS
Medicare Registration Application (CMS-855O)
Reinstatement without change of a previously approved collection   No
Regular
Improperly submitted 12/29/2016
Retrieve Notice of Action (NOA) 03/29/2016
  Inventory as of this Action Requested Previously Approved
36 Months From Approved
0 0 0
0 0 0
0 0 0

The publication of the Patient Protection and Affordable Care Act (PPACA), section 6405 - "Physicians Who Order Items or Services Required to be Medicare Enrolled Physicians or Eligible Professionals" (regulation CMS 6010-F), contains a requirement for certain physicians and non-physician practitioners to enroll in the Medicare program for the sole purpose of ordering or referring items or services for Medicare beneficiaries. The PPACA has an effective date applicable to written orders and certifications made on or after July 1, 2010. The CMS 855O allows a physician to receive a Medicare identification number (without being approved for billing privileges) for the sole purpose of ordering and referring Medicare beneficiaries to Medicare approved providers and suppliers. This new Medicare application form allows physicians who do not provide services to Medicare beneficiaries to be given a Medicare identification number without having to supply all the data required for the submission of Medicare claims. It also allows the Medicare program to identify ordering and referring physicians without having to validate the amount of data necessary to determine claims payment eligibility (such as banking information), while continuing to identify the physician's credentials as valid for ordering and referring purposes.

PL: Pub.L. 111 - 148 6405 Name of Law: Affordable Care Act
  
None

Not associated with rulemaking

  80 FR 76994 12/11/2015
81 FR 16184 03/25/2016
No

No
No
The burden increase is based the new burden amounts of data compiled from PECOS. The new estimates for completing the CMS-8550 Medicare enrollment application form for initial enrollment, reporting changes in enrollment information, and voluntarily withdrawal of enrollment information are taken directly from the actual applications processed for calendar year 2014 in PECOS. The new figures are exact and therefore more accurate than the prior estimates. In addition, CMS assessed (via PECOS) how many providers are currently prescribing based on their NPI and PDE data but are not currently enrolled in PECOS and therefore will complete and submit the revised CMS-8550 as Part D drug prescribers. Those assessed providers were added to the burden estimates. CMS estimates the new total annual burden associated with this information collection is approximately 243,600 hours.

$0
No
No
No
No
No
Uncollected
Jamaa Hill 301 492-4190

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
03/29/2016


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