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San Francisco Marin Medical Society Blog

New Reassignment of Medicare Benefits (855R) Enrollment Form



The Centers for Medicare and Medicaid Services (CMS) finalized a new 855R form, which is used to reassign an individual physician's Medicare billing privileges to an organization.

The revised form will become available on CMS.gov on December 29, 2014, and can be found by searching "855."

Once available, Medicare administrative contractors will accept both the current and revised versions of the form through May 31, 2015. The new version must, however, be used for applications received by the Medicare Administrative Contractor on or after June 1, 2015. Prior versions will be denied. The online Medicare Provider Enrollment, Chain and Ownership System (PECOS) will be updated to include the revised Medicare reassignment information.



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