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.
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
$0
No
No
No
Yes
No
No
No
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 CMS-855O Reporting Voluntary Withdrawal of Registration Information
CMS-855O - Supporting Statement - 30-dayOMB.docx
CMS 855O - Revisons Spreadsheet - 11202017.pdf
Reporting Voluntary Withdrawal of Registration Information