The CMS855I is used for individual provider enrollment in Medicare. It can be used by both physicians and non-physicians. Other necessary documentation will very between provider types.
Providers may also need to submit the CMS460 form to elect for participation in Medicare, without this form provider may be enrolled as non-participating providers. Non-participating providers will receive less reimbursement from Medicare, though they are also entitled to pursue more reimbursement directly from patients; up to 115% of the Medicare rate.
For providers enrolling under an existing group practice, the CMS855R form will need to be submitted. This form reassigns the provider’s financial payments to the business ender which their services are performed.
The CMS588 will be needed for both individual and group practices, in order to setup Electronic Funds Transfer to receive Medicare payments. Medicare does not issue paper checks; reimbursement is only dispensed via ETF.
Summary of applications:
- Solo practitioner forming a new business entity: CMS855I, CMS460, CMS588
- New provider joining an existing group: if already in enrolled with the state intermediary – form CMS855R; if not enrolled with the state intermediary – forms CMS855I, CMS855R
- Form CMS460 may be required for new enrollment depending upon the status of the group/supplier