Complete Medicare Enrollment and/or Updates

Application-Specific Changes for Institutional Providers

Application-Specific Changes for Physicians and Non-Physician Practitioners

Application-Specific Changes for Clinics/Group Practices and Other Suppliers

Change in Practice Location - when a physician establishes a new practice location, moves an existing practice location, closes an existing practice location or changes any portion of an address of an existing practice location address where Medicare information is sent.

Change in Final Adverse Action - when a physician is debarred or excluded by any Federal or State health care program, has his or her medical license suspended or revoked by a State licensing authority, was convicted of a felony within the last 10 years, has his or her Medicare billing privileges revoked by a Medicare contractor, or has a revocation or suspension by an accreditation organization.

Change of Business Structure - when a physician changes his or her business structure (e.g., sole proprietorship to sole incorporated owner or visa versa.)

Change in Organization Legal Business Name/Tax Identification Number - when a business owner changes the organization’s legal business name and/or Taxpayer Identification Number with the Internal Revenue Service.

Change in Reassignment of Benefits - when a physician adds or voluntarily withdraws his or her reassignment of Medicare benefits. Physicians must report this type of change on the CMS-855R.

Change in Banking Arrangements or any Payment Information - when a physician changes his or her bank or bank account or makes other payment information changes. This type of change should be reported immediately to the Medicare contractor. A physician can update his or her electronic funds transfer information by submitting the electronic funds transfer authorization agreement (CMS-588) to his or her Medicare contractor.

Reassignment of Benefits Application - A CMS-855R must be completed for any individual who is a W2 or 1099 employee or provides services in a healthcare facility and wants to reassign their benefits to an eligible Medicare provider. A 1099 employee must perform their services at the clinic/office site.