What are the new forms, and what form should I fill out?
A. There are five new forms that replace the existing ones. They are: • CMS 855A (for Health Care entities that will bill Medicare Fiscal Intermediaries) • CMS 855B (for Health Care organizations, such as group practices, that will bill Medicare Carriers) • CMS 855I (for Physicians and Individual Health Care Practitioners) • CMS 855R (for individual Reassignment of Benefits) • CMS 855S (for DMEPOS suppliers) In general, depending on the caller’s particular situation, if the caller is: • a health care entity that bills a fiscal intermediary, they should complete the CMS 855A. • a health care organization, such as a group practice, that bills a carrier, they should complete the CMS 855B. • a physician or an individual non-physician practitioner, s/he should complete the CMS 855I. • making a change in reassignment information, s/he should complete the CMS 855R. • a DMEPOS supplier, they should complete the CMS 855S. (Note to CSR’s: use the chart below for more information): If you are a(n
