Introduction: Why Medicare 855B Matters for Healthcare Providers
For group medical practices and certain healthcare organizations, enrolling in Medicare is essential to bill for covered services. The Medicare 855B form — also called the CMS-855B — is the official application for group practices and suppliers (excluding DMEPOS suppliers) to enroll, revalidate, or update their information in the Medicare program.
Understanding this form is crucial for compliance, avoiding reimbursement delays, and ensuring smooth operations within your practice. In this article, we break down what Medicare 855B is, who needs it, how to complete it, and common mistakes to avoid.
What is Medicare 855B?
Medicare 855B is an application used by:
-
Group medical practices (e.g., multi-physician offices)
-
Certain non-physician organizations (e.g., clinics, therapy groups)
-
Suppliers (except DMEPOS suppliers, who use 855S)
The form allows organizations to:
-
Enroll in Medicare for the first time
-
Change existing enrollment information (address, ownership, managing control)
-
Revalidate enrollment (required every 5 years or upon CMS request)
-
Add or remove reassignment of benefits for individual practitioners
Why is Medicare 855B Important?
-
Legal requirement: You cannot receive Medicare reimbursement without an active, approved enrollment.
-
Keeps records current: Ensures CMS has accurate ownership and practice information.
-
Prevents fraud: CMS uses the data to verify legitimacy and maintain program integrity.
-
Avoids payment delays: Outdated or incorrect information can lead to claim denials.
Who Must File Medicare 855B?
You must file Medicare 855B if you are:
-
A group practice (two or more providers billing under one Tax Identification Number)
-
A clinic or group supplier seeking to bill Medicare for covered services
-
A practice adding a new location, ownership change, or reassigning benefits
-
An organization revalidating Medicare enrollment as requested by CMS
When Should You Submit Medicare 855B?
-
Initial enrollment: Before billing Medicare for the first time
-
Revalidation: Typically every 5 years, when notified by CMS
-
Change of information: Within 30 days for ownership/control changes or 90 days for other updates
-
Voluntary withdrawal: When closing a practice or no longer participating in Medicare
Medicare 855B vs. Other Medicare Forms
-
855I: For individual practitioners (e.g., physicians, NPs) enrolling independently
-
855R: For reassigning benefits (linking individual practitioners to group practices)
-
855S: For suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)
The 855B specifically covers groups and certain organizations, not individual providers.
How to Complete Medicare 855B (Step-by-Step)
1. Gather Necessary Information
-
Legal business name (matching IRS records)
-
Tax Identification Number (TIN or EIN)
-
Practice location and contact details
-
Ownership and managing control data
-
Provider Identification Numbers (PTAN, NPI)
-
Reassignment agreements for individual providers
2. Choose Submission Method
-
PECOS (Provider Enrollment, Chain, and Ownership System): Online submission preferred by CMS
-
Paper application: Downloadable from CMS website (CMS-855B PDF)
3. Complete Each Section Carefully
-
Section 1: Basic information (enrollment type, purpose)
-
Section 2–3: Identifying information for organization and practice locations
-
Section 4: Ownership and managing control details
-
Section 5: Reassignment of benefits (if applicable)
-
Section 6: Adverse legal actions and sanctions disclosure
-
Section 7: Billing agency or delegated official information
-
Section 8: Certification statement and authorized signature
4. Submit Required Documentation
-
IRS CP-575 letter or SS-4 confirmation (proof of TIN/EIN)
-
Articles of incorporation or partnership agreements
-
State licenses and certifications
-
Reassignment agreements (if billing under group NPI)
5. Mail or Submit Electronically
-
Paper: Send to your Medicare Administrative Contractor (MAC) address listed in the instructions
-
PECOS: Submit electronically and track status online
Common Mistakes to Avoid
-
Mismatch between IRS name and application name
-
Missing signatures (must be signed by authorized official)
-
Incorrect NPI/TIN combinations
-
Not updating within CMS deadlines (30 or 90 days depending on change type)
-
Submitting incomplete ownership information (CMS requires full disclosure)
Processing Time and Follow-Up
-
Average processing time: 30–90 days
-
CMS may request additional documents or corrections during review. Respond promptly to avoid delays.
-
Once approved, you will receive a Medicare approval letter and PTAN (Provider Transaction Access Number).
Revalidation Process
-
Occurs every 5 years (or 3 years for DMEPOS suppliers)
-
CMS sends revalidation notices by mail and PECOS
-
Must update and confirm all practice details
-
Failure to revalidate leads to deactivation of billing privileges
Why Accurate 855B Submission Matters
-
Compliance with Medicare regulations
-
Avoidance of fraud investigations due to inconsistent ownership data
-
Uninterrupted reimbursements and cash flow for your practice
-
Smooth onboarding of new providers into group billing structures
Tips for Streamlining the Process
-
Use PECOS online system — faster and reduces errors
-
Maintain a compliance binder with all required documents ready for updates
-
Assign a designated enrollment coordinator to manage deadlines and updates
-
Keep copies of all submissions and CMS correspondence for audits
Related Regulatory Changes
CMS frequently updates provider enrollment rules. Recent updates include:
-
Increased screening for high-risk providers (e.g., fingerprinting for certain owners)
-
Mandatory electronic submission push via PECOS for efficiency
-
Stricter timelines for reporting ownership/control changes
FAQs About Medicare 855B
What is Medicare 855B used for?
For group practices and certain suppliers to enroll, revalidate, or update their Medicare information.
Who needs to file 855B?
Clinics, group practices, and certain organizations billing under a group NPI.
Can individuals use 855B?
No, individuals use Medicare 855I for enrollment and 855R for reassignment.
How long does approval take?
Typically 30–90 days, depending on completeness and MAC workload.
What happens if I don’t revalidate?
Your Medicare billing privileges may be deactivated, and claims will be denied until reinstated.
Key Takeaways
-
Medicare 855B is essential for group practice enrollment and compliance.
-
Submit via PECOS for efficiency and tracking.
-
Keep information accurate and updated to prevent claim denials.
-
Revalidate every 5 years or as requested by CMS.
-
Missing deadlines or incomplete forms can result in billing interruptions.
Conclusion
For healthcare organizations and group practices, mastering the Medicare 855B application is critical to maintaining compliance and uninterrupted reimbursement. Whether enrolling for the first time, adding providers, or updating ownership details, careful completion and timely submission safeguard both your practice’s operations and your patients’ access to care.
Regularly reviewing CMS updates and staying organized ensures smooth navigation of the Medicare enrollment process — keeping your focus where it belongs: providing quality patient care.
Disclaimer
This article is for informational purposes only and does not replace professional legal or compliance advice. Always consult CMS guidelines or a healthcare attorney for specific enrollment questions.
