Medicare Registration Application (CMS-855O)

ICR 202201-0938-006

OMB: 0938-1135

Federal Form Document

Forms and Documents
Form and Instruction
Form and Instruction
Form and Instruction
Supporting Statement A
Supplementary Document
ICR Details
0938-1135 202201-0938-006
Received in OIRA 201804-0938-024
Medicare Registration Application (CMS-855O)
Reinstatement with change of a previously approved collection   No
Regular 01/10/2022
  Requested Previously Approved
36 Months From Approved
60,209 0
30,105 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
PL: Pub.L. 116 - 136 3708 Name of Law: Coronavirus Aid, Relief, and Economic Security Act

Not associated with rulemaking

  86 FR 18536 04/09/2021
86 FR 74415 12/30/2021

  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 60,209 0 -34,991 0 0 95,200
Annual Time Burden (Hours) 30,105 0 -3,495 0 0 33,600
Annual Cost Burden (Dollars) 0 0 0 0 0 0
As previously explained, section 3708 of the CARES Act expands § 424.507(b)(1) to allow NPs, CNSs, and PAs to certify the need for home health services. This will require the completion of the CMS-855O application. This burden is reflected in the burden estimate. With the use of the PECOS system, updated information technology allows CMS to accurately count the hours per submittal reason and consequently, total annual hours. There are three submission reasons for completion of the CMS-855O enrollment application (initial enrollment, reporting a change of Medicare enrollment information, and voluntary termination of Medicare enrollment). Currently, the burden hours for the entirety of all submission reasons and respondents is 30,105 hours annually (over a three-year period 90,314 hours) with approximately 60,209 respondents. Both the burden hour per submission reason as well as the respondents are valued and calculated in this burden estimate.? It’s all

Jamaa Hill 301 492-4190


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.

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