Get the free 855i form

855i is a CMS (Centers for Medicare and Medicaid Services) form used for enrollment and participation in the Medicare program as an individual practitioner or a group practice. It is specifically used by healthcare providers to enroll and obtain a National Provider Identifier (NPI) for Medicare billing purposes. The form includes information about the provider or group practice, their practice details, and other necessary information to establish their eligibility for participation in the Medicare program.

The form 855I is required to be filed by individual and organizational providers of medical or healthcare services who are seeking to enroll or update their enrollment in the Medicare program.

To fill out the CMS-855I form, which is used for initial enrollment in the Medicare program, follow these steps: 1. Begin by providing your personal information in Section 1. This includes your full name, Social Security number, date of birth, and contact details. 2. In Section 2, indicate if you are applying as an individual practitioner or as an organization. If you are applying as an individual, skip to Section 4. If applying as an organization, provide the organization's legal business name, type, address, contact information, and the name and address of the authorized official. 3. Section 3 is for reporting changes in your information. If you are not reporting any changes, you can skip this section. 4. In Section 4, list the applicable practice location(s) where you will be providing services. Include the address, type of service, group practice name (if applicable), and other relevant details. 5. Section 5 asks for your practice's special payment arrangements, such as participating in a group practice or receiving capitation payments. Answer accordingly. 6. Provide information on any affiliations or other providers involved in your practice in Section 6. 7. Section 7 asks about any adverse legal actions or payment suspensions that you or your organization may have encountered. Disclose any applicable information. 8. Section 8 requires details on any final adverse actions taken against you by another organization. 9. Section 9 asks if you have any existing Medicare provider agreements and if you would like them terminated. 10. Section 10 is a certification statement that requires your signature, date, and contact information. 11. Finally, ensure that all other required attachments, such as supporting documentation or identification, are included with your application. Remember to thoroughly read the instructions provided along with the form to ensure accurate completion and submission.

The purpose of Form 855I, also known as the Medicare Enrollment Application for Physicians and Non-Physician Practitioners, is to enroll or make changes to an existing enrollment in the Medicare program. This form is used by physicians and non-physician practitioners, such as nurse practitioners or physician assistants, who want to participate in the Medicare program and provide services to Medicare beneficiaries. It includes necessary information about the healthcare provider, their practice, and their credentials to determine their eligibility for Medicare enrollment.

The 855i form is used by healthcare providers and organizations to report and update their enrollment information in the Medicare program. It includes various sections where specific information must be provided. The information that needs to be reported on the 855i form includes: 1. General Information: This section asks for basic information about the provider or organization, such as the legal business name, address, contact information, and tax identification number. 2. Identity and Oversight Information: Here, providers need to provide details about the authorized or delegated official responsible for enrollment. This includes their name, position, and contact information. 3. Provider Practice Location Information: Providers must list all practice locations where Medicare services are furnished. This includes the address, contact information, and the type of services provided at each location. 4. Billing Agency/Service Information: If a billing agency or service organization is used, their information must be provided in this section. This includes the name, address, contact information, and details of the services they provide. 5. Medicare Specialty Information: Providers are required to indicate the type of specialty or service they provide, such as family practice, internal medicine, cardiology, etc. 6. Medicare Services Information: This section requires providers to indicate the specific Medicare services they plan to provide and receive payment for. This may include inpatient, outpatient, home health, durable medical equipment, etc. 7. Affiliation and Ownership Information: Providers must disclose any ownership or affiliation with other healthcare entities, organizations, or individuals. 8. Supplemental Information: Additional information that may be necessary to complete the enrollment process, such as any pending legal actions, bankruptcy, or changes in ownership. It's important to note that the 855i form is subject to change based on updates by the Centers for Medicare & Medicaid Services (CMS). Therefore, it's always advisable to refer to the most current version of the form and any instructions provided by CMS.

The deadline to file Form 855I in 2023 would be during the tax year 2022, typically by April 15th, 2023. Since tax deadlines can occasionally shift, it is recommended to verify the exact date with the Internal Revenue Service (IRS) or a tax professional to ensure compliance.

The penalty for the late filing of Form 855i depends on the specific circumstances and the policies of the relevant government agency. In general, if a healthcare provider fails to submit the form by the required deadline, they may face penalties such as fines, a delay in processing their enrollment or revalidation application, or even potential denial of their application. It is important to consult the guidelines and regulations of the specific agency involved to determine the exact penalties for late filing.

The pdfFiller mobile applications for iOS and Android are the easiest way to edit documents on the go. You may get them from the Apple Store and Google Play. More info about the applications here. Install and log in to edit cms855i form.

Use the pdfFiller app for iOS to make, edit, and share medicare 855i from your phone. Apple's store will have it up and running in no time. It's possible to get a free trial and choose a subscription plan that fits your needs.

Download and install the pdfFiller iOS app. Then, launch the app and log in or create an account to have access to all of the editing tools of the solution. Upload your medicare form 855i from your device or cloud storage to open it, or input the document URL. After filling out all of the essential areas in the document and eSigning it (if necessary), you may save it or share it with others.