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).