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The document is the Medicare Enrollment Application for the Reassignment of Medicare Benefits (CMS-855R). It outlines the process for individual practitioners and organizations to reassign their rights to bill Medicare and receive payments for services rendered. The application must be completed by eligible practitioners or organizations, detailing necessary information such as identification numbers and practice locations. It includes instructions for submission, certification statements, and privacy information regarding data handling.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (72 Votes)
2016	4.4 Satisfied (320 Votes)
2006	4 Satisfied (26 Votes)

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What is the CMS form 855R?

❖ 855R. CMS form which establishes a reassignment of your right to bill the Medicare. program and receive Medicare payments. Reassigning your Medicare benefits means that an individual will allow an. eligible Part B provider to submit claims and receive payment for Medicare.

Is the CMS-855R being discontinued?

CMS has discontinued the CMS-855R (Reassignment of Medicare Benefits) form and updated its CMS-855I provider enrollment form.

Is the 855R discontinued?

The CMS-855R (Reassignment of Medicare Benefits) form has been discontinued. For additional information regarding the Medicare enrollment process (including Internet-based PECOS) and to get the current version of the CMS-855I, go to CMS.gov/Medicare/Provider-Enrollment-and-Certification.

What is the difference between CMS-855I and 855R?

CMS-855I: For employed physician assistants (sections 1, 2, 3, 13, and 15). CMS-855R: Individuals reassigning (entire application). CMS-855O: All eligible physicians and non-physician practitioners (entire application). Same applications are required as those of new enrollees.

What is the CMS form 855B?

What is the 855B? ❖ The CMS form used for the enrollment of Clinic/Group practices and Certain Other Suppliers. This form is also used to submit changes to your enrollment data.