The primary function of the (CMS-855A,B,I) Medicare enrollment application is to gather information from a provider or supplier that tells us who it is, whether it meets certain qualifications to be a health care provider or supplier, where it practices or renders services, the identity of the owners of the enrolling entity, and other information necessary to establish correct claims payments. For reasons discussed below, CMS is revising the CMS-855 Medicare Enrollment Applications Package (OMB No. 0938-0685).
US Code:
42 USC 1395m
Name of Law: SPECIAL PAYMENT RULES FOR PARTICULAR ITEMS AND SERVICES
PL:
Pub.L. 105 - 33 4313
Name of Law: Provision of certain identification numbers
PL:
Pub.L. 104 - 134 31001(I)
Name of Law: Debt Collection Improvement Act of 1996
US Code:
42 USC 1395f
Name of Law: Conditions of and Limitations on Payment for Services
US Code:
42 USC 1395g
Name of Law: Payment to Providers of Services
US Code:
42 USC 1395cc
Name of Law: AGREEMENTS WITH PROVIDERS OF SERVICES; ENROLLMENT PROCESSES
US Code:
42 USC 1395l
Name of Law: Payment of Benefits
US Code:
42 USC 1395u
Name of Law: Provisions related to the Administration of Part B
PL:
Pub.L. 111 - 148 6001
Name of Law: Affordable Care Act
CMS is removing the CMS-855R application from the CMS-855 Medicare Enrollment Applications Package (OMB No. 0938-0685). On May 22, 2013, in accordance with the Paperwork Reduction Act, OMB approved a reinstatement without change of a previously approved collection of the Medicare enrollment applications (specifically, the CMS-855A, CMS-855B, CMS-855I and CMS-855R Medicare enrollment application bundle, OMB number 0938-0685, ICR reference number 201210-0938-009). This was necessary in order to allow the CMS-855A, CMS-855B and CMS-855I to remain active. That collection expires on May 31, 2016. While the CMS-855R enrollment form was included in that collection, it was not active and was not being used by the public as CMS now uses the revised CMS-855R, OMB number 0938-1179, approved by OMB on November 1, 2012 (ICR reference number 201206-0938-007) and renewed via approval by OMB on April 15, 2016 (ICR reference number 201509-0938-008). The CMS-855R application under OMB number 0938-0685 is now being removed from the Medicare application bundle collection. There is no duplication of CMS-855R Medicare application forms as only the CMS-855R Medicare application form under OMB approval number 0938-1179 is active. Therefore, CMS is seeking to redefine the CMS-855 Medicare Enrollment Applications Package (OMB No. 0938-0685) to include only the CMS-855A, CMS-855B, and CMS-855I enrollment applications.
The adjustments to the total burden (number 12, Table 4) reflect the removal of the CMS-855R from this CMS-855 enrollment package. The total respondents were reduced by 7,400, making the new total 1,733,400. The annual burden hours were reduced by 1,218, making the new total 289,393 hours. The small amount of burden hours removed by the CMS-855R does not significantly impact the burden hours of this collection. The total cost was reduced by $12,879,435, which reflects the $8,320 reduction from the CMS-855R removal as well as the reduction from using the Bureau of Labor Statistics (BLS) wage rates, making the new total $18,386,355. This significant reduction is due to CMS estimation of using a wage rate of $150 per hour for professional staff rather than $81.84 as reported by the BLS. As previously mentioned, CMS determined the wage rates based on the most recent data from the Bureau of Labor Statistics, which include fringe benefits and overhead.
$0
No
No
Yes
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.
Form 855B Medicare Enrollment Applications
CMS-855(ABI) Supporting Statement - 08112016.docx
Medicare Enrollment Applications