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