Medicare Enrollment
Application for Institutional Providers (CMS-855A)
Revision of a currently approved collection
No
Regular
08/18/2020
Requested
Previously Approved
36 Months From Approved
12/31/2021
302,999
1,733,400
97,342
289,393
0
0
The CMS-855A application is submitted
at the time the applicant first requests a Medicare billing number.
The application is used by Medicare contractors to collect data to
ensure that the applicant has the necessary credentials to provide
the health care services for which they intend to bill Medicare,
including information that allows the Medicare contractor to
correctly price, process and pay the applicant’s claims. It also
gathers information that allows Medicare contractors to ensure that
the provider/supplier is not sanctioned from the Medicare program,
or debarred, suspended or excluded from any other Federal agency or
program.
PL:
Pub.L. 104 - 134 31001(I) Name of Law: Debt Collection
Improvement Act of 1996
US Code: 42
USC 1395g Name of Law: Payment to Providers of Services
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
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
US Code: 42
USC 1395f Name of Law: Conditions of and Limitations on Payment
for Services
The proposed changes in this
2020 collection of information request is associated with our
August 17, 2020 (85 FR 50074) proposed rule (CMS-1734-P, RIN
0938-AU10). Overall, the changes amount to a reduction of 1,430,401
responses, 192,051 hours, and $17,136,173. Please see section 15 of
the attached Supporting Statement for details.
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.