New Medicare Enrollment Application

Medical Enrollment Form

There is a new version of the CMS-855I Medicare Enrollment Application, which physicians and non-physician practitioners may begin using immediately. Medicare Administrative Contractors will accept the previous version of the application (7/2011) through April 30, and then require you to use the new version (12/18).

What’s Changed?

The Centers for Medicare & Medicaid Services (CMS) has made the following changes to the form “to reduce provider burden:”

  • Reporting for advanced diagnostic imaging, the Clinical Laboratory Improvement Amendments number, and the Food and Drug Administration radiology certification number is no longer required.
  • Instructions for individual and group affiliations are expanded.
    • In section 4F, you are instructed to include information about all entities to whom you will be reassigning any or all of your Medicare benefits.
  • Listing a contact person is optional.
  • Information on electronic storage (for those who no longer keep paper records) is added.
    • If your current/past Medicare patients’ medical records are stored at a location other than the practice location address given in section 4B, you must provide the name and address of the electronic and/or paper storage location(s) in section 4D.
Who’s Affected?

All physicians and other qualified healthcare professionals (as defined in section 1848(k)(3)(B) of the Social Security Act) must use the CMS-855I (or PECOS) to enroll in the Medicare program and receive a Medicare billing number.

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