Clinic Group Practice Reassignment

$447.50 / year

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.

Complexity

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).

Date Created

2016-03-25

Last Modified

2020-02-28

Version

2020-02-28

Update Frequency

Irregular

Temporal Coverage

2019-2020

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

NameDescriptionTypeConstraints
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_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
Group PAC IDGroup Enrollment IDGroup Legal Business NameState AbbreviationGroup Due DateGroup Reassignments and Physician AssistantsRecord TypeIndividual Enrollment IDIndividual NPIIndividual First NameIndividual Last NameIndividual Specialty DescriptionIndividual Due DateIndividual Total Employer Associations
1153364203O20050609000145A & A Audiology, PcTX1ReassignmentI200506090001721306861356ToniaFlemingQualified Audiologist2
1759440886O20081105000006A & A Chiropractic. LlcNJ2019-10-311ReassignmentI200808190001321134399694SharonBarnumChiropractic2019-10-311
1153442256O20101222000765A & A Eye Associates, PcPA2017-09-302ReassignmentI201012220008891538154588DanielAndersonOptometry2017-09-301
1153442256O20101222000765A & A Eye Associates, PcPA2017-09-302ReassignmentI200911180001491407852296AmandaTemnykhOptometry2016-07-311
3274425004O20040326000876A & A Health Systems, IncMS2020-08-311ReassignmentI200403290005001063479723SheryllVincentPediatric Medicine2020-08-311
648317685O20091026000039A & A Optical IncNY2019-12-313ReassignmentI200407160005131548265226VeroniqueGermaineOptometry2020-06-302
648317685O20091026000039A & A Optical IncNY2019-12-313ReassignmentI200402090002761982697702AngelikaKaralnikOptometry3
648317685O20091026000039A & A Optical IncNY2019-12-313ReassignmentI200403300014081730222704FloraLevineOptometry2017-06-302
9436348513O20110105000073A & A Psychotherapy Associates PcMI2017-07-311ReassignmentI201101050001021508974783JuanArellano LopezClinical Social Worker2017-07-311
6103152269O20190726001094A & B Counseling Services LlcFL7ReassignmentI202001230001621063725588CirceDunwoodyClinical Social Worker1