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The document is a Medicare Enrollment Application (CMS-855O) for eligible physicians and professionals who wish to enroll in the Medicare program specifically to order or certify items and services for Medicare beneficiaries. It outlines the eligibility criteria, application process, required information, and penalties for providing false information. The form must be completed accurately and submitted to the appropriate Medicare Administrative Contractor (MAC) for processing.

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Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (122 Votes)
2013	4.4 Satisfied (51 Votes)

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What is CMS 855O form?

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.

What is a CMS 460 form?

CENTERS FOR MEDICARE & MEDICAID SERVICES. INSTRUCTIONS FOR THE MEDICARE PARTICIPATING PHYSICIAN. AND SUPPLIER AGREEMENT (CMS-460) To sign a participation agreement is to agree to accept assignment for all covered services that you provide to Medicare patients.

Is CMS 460 required for revalidation?

No, the CMS-460 is not required. 15. How long after I receive my revalidation letter do I have to submit the revalidation application? Your revalidation application is required by the revalidation due date listed in your revalidation letter.

What is the difference between an 855O and 855I?

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.