Others titles

  • Medicare Enrollment Application
  • Physicians and Non-Physician Practitioners
  • Reassigning Medicare Benefits
  • Terminating a Reassignment with Clinic Group

Keywords

  • Clinic Group Practice
  • Provider Enrollment Chain
  • Medicare Enrollment Application
  • Reassignment of Benefits
  • Enroll a Group Practice
  • Enroll a Clinic Group
  • Revalidate Reassignments
  • Terminating a Reassignment

Clinic Group Practice Reassignment

This dataset shows the clinic group practice reassignment. Providers and suppliers must apply for enrollment in the Medicare program or make a change in their enrollment information using either the Internet-based Provider Enrollment Chain and Ownership System or the paper enrollment application process.

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Description

The CMS-855R application is used by individual physicians and non-physician practitioners (hereafter collectively referred to as “individual practitioners”) who want to reassign their right to receive Medicare payments to another eligible individual or entity (i.e., sole proprietorship/clinic/group practice/other healthcare organization); Medicare eligible professionals may also reassign their benefits to a critical access hospital (CAH) that bills Method II in order to participate in the Electronic Health Records (EHR) Incentive Program for Eligible Professionals (EPs). In addition, the CMS-855R is used to terminate a currently established reassignment of benefits.

Reassigning Medicare benefits allows an eligible individual or entity to submit claims on behalf of and receive payment for Medicare Part B services that the performing practitioner provides for the eligible billing individual or entity. Both the individual practitioner and the eligible individual or entity must be currently enrolled (or concurrently enrolling via submission of the (1) CMS-855I/CMS-855B for the eligible individual or entity and (2) the CMS-855I for the individual practitioner) in the Medicare program before the reassignment can take effect.

A separate CMS-855R must be submitted for each individual practitioner or eligible individual or entity for which a reassignment is being established or terminated. The individual practitioner may receive multiple Provider Transaction Access Numbers (PTANs) under a single Employer Identification Number (EIN), but may not reassign benefits to more than one EIN on a single CMS-855R application.

The CMS-855R shall not be used to report employment arrangements of physician assistants. Employment arrangements for physician assistants must be reported on the CMS-855I application. In addition, a CMS-855R application is not required to be submitted with a CMS855B for an independent diagnostic testing facility (IDTF) that employs or contracts with interpreting physicians.

The CMS-855R shall not be used to revalidate reassignments. The individual practitioner should only use the CMS-855I and list his/her active reassignment information in section 4B thereof. The CMS-855R application is required to terminate a reassignment. The termination cannot be done via the CMS-855I form (except for Internet-based PECOS applications when the termination is for the last PTAN on an enrollment).

About this Dataset

Data Info

Date Created

2016-03-25

Last Modified

2022-11-01

Version

2022-11-01

Update Frequency

Monthly

Temporal Coverage

2016-2023

Spatial Coverage

United States

Source

John Snow Labs; Centers for Medicare & Medicaid Services;

Source License URL

Source License Requirements

N/A

Source Citation

N/A

Keywords

Clinic Group Practice, Provider Enrollment Chain, Medicare Enrollment Application, Reassignment of Benefits, Enroll a Group Practice, Enroll a Clinic Group, Revalidate Reassignments, Terminating a Reassignment

Other Titles

Medicare Enrollment Application, Physicians and Non-Physician Practitioners, Reassigning Medicare Benefits, Terminating a Reassignment with Clinic Group

Data Fields

Name Description Type Constraints
Group_PAC_IDPAC ID of provider who is receiving reassignment or is the employer.integerlevel : Nominal
Group_Enrollment_IDEnrollment ID of provider who is receiving reassignment or is the employer.string-
Group_Legal_Business_NameLegal business name of provider who is receiving reassignment or is the employer.string-
State_AbbreviationEnrollment state of provider who is receiving reassignment or is the employer.string-
Group_Due_DateRevalidation due date of provider who is receiving reassignment or is the employer.date-
Group_Reassignments_and_Physician_AssistantsNumber of individual enrollment associations that are reassigning benefits to or are employed by the organizational provider.integerlevel : Nominal
Record_TypeIdentifies whether the record is for a reassignment ('Reassignment') or employment ('Physician Assistant')string-
Individual_Enrollment_IDEnrollment ID of provider who is reassigning their benefits or is an employee.string-
Individual_NPIA National Provider Identifier or NPI is a unique 10-digit identification number issued to healthcare providers in the United States by the Centers for Medicare and Medicaid Services (CMS).integerlevel : Nominal
Individual_First_NameFirst name of provider who is reassigning their benefits or is an employee.string-
Individual_Last_NameLast name of provider who is reassigning their benefits or is an employee.string-
Individual_State_CodeEnrollment state of provider who is receiving reassignment or is the employee.string-
Individual_Specialty_DescriptionEnrollment specialty description of the provider who is reassigning their benefits or is an employee.string-
Individual_Due_DateRevalidation due date of the provider who is reassigning their benefits or is an employee (TBD if yet to be assigned)date-
Individual_Total_Employer_AssociationsNumber of organizational enrollment associations to which the individual provider reassigns benefits or is employed by.integerlevel : Nominal

Data Preview

Group PAC IDGroup Enrollment IDGroup Legal Business NameState AbbreviationGroup Due DateGroup Reassignments and Physician AssistantsRecord TypeIndividual Enrollment IDIndividual NPIIndividual First NameIndividual Last NameIndividual State CodeIndividual Specialty DescriptionIndividual Due DateIndividual Total Employer Associations
3678655222O20080205000002#1 Wise Podiatry Care P.C.NY2019-10-311ReassignmentI200406020017111710912209YelenaVoronovaNYPodiatry2019-10-315
6305933532O20071103000162'a' Street Clinic Of Chiropractic, PllcWA2020-07-311ReassignmentI200710290006531033274154DonaldOlsonWAChiropractic2020-07-311
5496843930O20071115000661(Riverside Family Medicine)TN5ReassignmentI201801300012101407367683RoxanneBrownTNNurse Practitioner1
5496843930O20071115000661(Riverside Family Medicine)TN5ReassignmentI201911270002391467909432AndrewDozierTNClinical Psychologist2
5496843930O20071115000661(Riverside Family Medicine)TN5ReassignmentI200703200004971184697898KennethDozierTNFamily Practice1
5496843930O20071115000661(Riverside Family Medicine)TN5ReassignmentI200808140005811285615278TonyFreemanTNFamily Practice2
5496843930O20071115000661(Riverside Family Medicine)TN5ReassignmentI201112020006091609840131PeterGeleskieTNFamily Practice2018-12-311
3274795547O201205020004991 Community Wellness & Health IncCA2017-03-312ReassignmentI200908260007081104995919AlexanderAbaryCAInternal Medicine1
3274795547O201205020004991 Community Wellness & Health IncCA2017-03-312ReassignmentI200403240015891598812596AmableAguiluzCAGeneral Practice2019-03-3112
1658693460O201412050016561 Cp Place PllcTX2022-12-312ReassignmentI201802200018891518404664JamesArnoldTXPhysical Therapist In Private Practice1