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The CMS 855A for Home Health and Hospice


Providers enrolling in the Medicare program are required to complete the CMS 855A in order to obtain billing privileges.  The CMS 855A Medicare Enrollment Application must also be completed whenever enrollment information needs to be added, deleted, or changed.  Most importantly, information must be submitted in a timely fashion to maintain billing privileges.

In completing the 855A, providers are being asked to certify that they are in compliance with all applicable federal and state licensure requirements.  This includes certifying that they do not employ or contract with individuals or entities that are excluded from the Medicare or Medicaid Program.  For more information, visit http://exclusions.oig.hhs.gov.

Institutional providers, including home health and hospice, must submit an application fee when initially enrolling, revalidating their enrollment or adding a new Medicare practice location.  The fee for 2015 is $553.  Attach a receipt with your 855A submission to the MAC. This fee is paid via https://pecos.cms.hhs.gov/pecos/feePaymentWelcome.do

Some examples for filing a CMS 855A form and submission time requirements include:

  • Initial enrollment resulting in issuance of a Medicare provider number
  • Additions, deletions, and changes of address (90 Days)
  • Managing/directing employee or authorized/delegated official change (90 days)
  • Stock transfers greater than 5% (30 Days)
  • Change of ownership (previous owner and new owner) (30 Days)
  • Mergers and acquisitions (acquiring and acquired owners) (30 Days)
  • Revalidations (60 days)

Please note: If you change your address or make a change to your banking arrangements, you must also file a CMS 588 Electronic Funds Transfer (EFT) Authorization Agreement to update your information.

For questions or assistance in filing your CMS 855A form please contact Nancy Boyd, Senior Manager, Simione Healthcare Consultants, at 1-877-424-6527 or [email protected].