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CMS 855S Enrollmentand Policy OverviewMichael Cimmino, Technical Advisor,CMSMichael J. Holoman, Senior ProviderEducation Representative, NSCSeptember 7, 2017
Session Overview Learn how to initially enroll, revalidate, and submitchanges of information for suppliers of DurableMedical Equipment, Prosthetics, Orthotics, andSupplies (DMEPOS)Cover all aspects of completing the CMS-855S with awalkthrough of both the paper and PECOS versions ofthe formLearn how to avoid common mistakes whensubmitting the CMS-855S2
What is the 855S? The CMS form which is used for the enrollment ofDMEPOS suppliers The National Supplier Clearinghouse (NSC) is theenrollment contractor responsible for processing allDMEPOS supplier applications3
Getting Started-The 855S Application You can find the 855S atthe following s/Downloads/cms855s.pdf4
DMEPOS Supplier Standards Full version can be found at42 CFR 424.572: Changes of Information5 & 6: Warranty Agreements9: Telephone requirements11 & 12: Beneficiary Contact16: Distributing Standards22: Accreditation26: Surety Bonds29: Practice location30: Hours of Business5
Who should complete the 855S? Suppliers enrolling for the first timeCurrently enrolled suppliers reporting changesSuppliers enrolling a new locationSuppliers needing to revalidateReactivation and voluntary termination6
Obtaining an NPI Suppliers must obtain an NPI and furnish it on theapplication prior to enrollingLBN and TIN must match NPPESSuppliers can apply for an NPI using the followinglink: https://nppes.cms.hhs.gov/#/7
855S Instructions8
Helpful 855S Information9
Section 1A & B - Business Location/Identification 10Business Location Locationchanges must bereported to CMSvia the 855Swithin 30 daysBusinessIdentification
Section 1C - Reason for Submission11
Section 1D - What Information is Changing12
Section 2A - Business Location Information13
Section 2B - Hours of Operation 14Min of 30hours perweek
Section 2C & D - Business Structure15
Section 2 E - States Where Items Provided16
Section 3A - Type of Supplier17
Section 3B & C - Accreditation Information Be sure to report an accreditation that includes all supplies you will beproviding, this will impact claims’ payment Accreditation is required18
Section 3D - Products and Services You must supply theappropriate licensureand/or certification asfailure to do so may leadto revocation or denialof your billing privileges Accredited products andservices only19
Section 4A - Address Information20
Section 4B - Correspondence Address This is used to contact the provider21
Section 4C - Revalidation Mailing Address Your request/reminder to revalidate will be sent to thisaddress22
Section 4D - Special Payment Address New enrollees must submit an EFT Authorization Agreement(CMS-588)23
Section 4E - Medical Records Storage Where/how areyou storingbeneficiary medicalrecords PO Boxes and dropboxes are notacceptable24
Section 5 - Comprehensive Liability Insurance25 All suppliers musthavecomprehensiveliability insurancein the amount ofat least 300,000for each incident Certificateliability isrequired to besubmitted (NSCmust be listed ascertificate holder)
Section 5 - Comprehensive Liability Insurance (cont.)26
Section 6A & B - Surety Bond Information 27All suppliers requiredto obtain a suretybondThis applies to anypersons enrolling asa DMEPOS supplier,regardless of otherexisting Medicareenrolled providertypes (i.e., Physician,etc.)Surety is required tobe submitted to theNSC
Section 6A & B - Surety Bond Information (cont.)28
Section 7 - Final Adverse Legal Actions29
Section 8 - Ownership Interest/Managing Control (Orgs) This section is for reportingorganizations; individualswill be reported in section 9 All organizations with 5% ormore direct or indirectownership interest, anypartnership interest, and/ormanaging control must bereported26
Section 8A - Ownership Interest/Managing Control (Orgs)31
Section 8B - Ownership Interest/Managing Control (Orgs)32
Section 9 - Ownership Interest/Managing Control (Inds) This section is forreporting individuals;organizations arereported in section 8 All individuals with 5% ormore direct or indirectownership interest, anypartnership interest,and/or managing controlmust be reported33
Section 9A - Ownership Interest/Managing Control (Inds) All individuals arerequired to undergofingerprint-basedcriminal backgroundchecks34
Section 9B - Ownership Interest/Managing Control (Inds)35
Section 10 - Billing Agency Information If you contractwith an entity orindividual toprepare andsubmit your claimstheir informationshould be suppliedhere36
Section 11 - Contact Person Information This is theperson who willbe contactedfor questionsregarding onlythis application37
Section 12 - Supporting Documents All applicable ormandatorydocuments mustbe included inorder to avoiddelays inprocessing yourapplication38
Section 13 - Penalties for Falsifying Information39
Section 14 - Assignment of Delegated Officials An individual whois delegated theauthority toreport changesand updates tothe supplier’senrollment recordby an authorizedofficial40
Section 15A - Authorized Official Certification Statement and Signature41
Section 15B - Authorized Official Signature(s) All AOs must bereported insection 9 and atleast one mustsign in section 15here42
Privacy Act Statement Yourinformationwill beentered intoPECOS43
NSC RemindersMedicare Enrollment Fees DMEPOS Suppliers CY 2017 - 560 Non-refundable Credit Card, Debit Card, Electronic Check New locations, Additional Locations, Revalidations&Reactivations, Applications are not processed until funds are elcome.do44
ResourcesMailing AddressPalmetto GBANational Supplier ClearinghouseP.O. Box 100142Columbia, SC 29202-3142Overnight Mailing AddressPalmetto GBANational Supplier Clearinghouse AG-4902300 Springdale Dr., Bldg. 1Camden, SC 29020Phone Number (866) 238-9652, M-F 9:00 AM - 5:00 PM, EThttp://www.PalmettoGBA.com/NSCE-mail: Medicare.NSC@PalmettoGBA.com45
Resources Online Application Status Tool Search by PTAN, NPI, TIN, DCN www.palmettogba.com/nsc Interactive Voice Response (IVR) Unit General information regarding the enrollment process Information on the appeals process Status of applications Instructions on how to obtain a CMS 855S Contact information for the NSC, DME MAC and CMSThe IVR is available 24 hours a day, seven days a week (except for routinesystem maintenance) and can be accessed by calling the NSC CustomerService Line at (866) 238-965246
NSC Web Submission Form 855S notrequired Appeals Licenses Surety bonds Certificates ofinsurance47
Questions48
Suppliers enrolling for the first time Currently enrolled suppliers reporting changes Suppliers enrolling a new location . Columbia, SC 29202- 3142. Overnight Mailing Address. Palmetto GBA. National Supplier Clearinghouse AG -490. 2300 Springdale Dr., Bldg. 1. Camden, SC 29020.
