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Most Common Errors on the CMS 855A
- Section 1A
-
- Marking the wrong reason for submitting the application
- Missing the NPI and Medicare number on Change of Ownership and
Change of Information applications.
- On CHOW applications, the NPI reported for new owner is the NPI
of the old owner. New owner needs a NPI for the facility that matches
the legal business name and tax id number for the new owner.
- Section 1B
-
- Failure to complete all sections required for the type of application
being submitted
- Section 2A
-
- Marking the incorrect type of provider
- Section 2B1
-
- Legal Business Name does not match IRS documentation.
- Missing IRS Documentation.
- Missing the Medicare Year-End cost report date.
- Missing the Incorporation Date and State where incorporated
- Missing incorporation documentation
- For sole proprietor, the tax identification number (TIN) is the
individual's SSN not the Employer Identification Number (EIN)
for the provider.
- For sole proprietor, the name on the 1st line of the IRS CP575
is the legal business name. The name on the 2nd line is the Doing
Business Name (DBA) name.
- Section 2B2
-
- Failure to check not applicable box if not completing this section
for licensure
- Failure to check not applicable box if not completing this section
for certification
- Section 2C
-
- The address for the facility is missing.
- Failure to provide the additional 4 digits of the zip code
- Section 2D
-
- This section does not have "yes" or "no" marked.
- Section 2F
-
- The legal business name does not match the one reported in Section
2B1 of the old owners CHOW 855A.
- Section 3
-
- This section does not have "yes" or "no" marked.
- Section 4A
-
- City/Town or State left blank.
- The zip code is missing the additional 4 digits
- Missing telephone and fax numbers
- NPI number missing and/or no NPI documentation attached.
- NPI documentation does not match name or address on 855A.
- The NPI reported is for a physician and not the facility
- For a CHOW, the NPI reported in 4A does not match the NPI reported
in 1A.
- CLIA number is missing. Enter "N/A" if it does not
apply or "Pending" if you have applied but not received
the number.
- Medicare number reported is not a Part A or OSCAR number.
- For sole proprietor, the NPI reported on the 855 should be associated
with the individuals SSN in NPPES.
- Section 4B
-
- EFT (CMS Form 588) agreement and/or documentation is missing
- Did not answer special payments address, or did not include the
plus 4 in the zip code.
- Section 5A
-
- This section should have the box marked for Not applicable or be
completed.
- Zip code is missing the additional 4 digits.
- Failure to complete this section for the home office in Section
7.
- Missing IRS documentation for tax id numbers for all entities reported.
- Section 5B
-
- If 5A is completed then this section should be answered "yes
or no".
- If 5A is not completed then this section should be left blank.
- Section 6A1
-
- Entire section is left blank. This section should be completed
for each officer, owners, partners and/or managing employees of the
facility.
- Failure to report at least one person as a managing employee.
- Failure to complete this section for the authorized and/or delegated
official.
- Failure to complete this section for the Administrator or CEO of
the home office in Section 7.
- Missing or incorrect Social Security numbers or dates of birth
- Reporting NPI and Medicare number that do not belong to the individual
in this section.
- Section 6A2
-
- Failure to mark fields all that apply.
- Failure to report at least one person as a managing employee.
- Section 6B1
-
- If 6A is completed then this section should be answered "yes
or no".
- If 6A is not completed then this section should be left blank.
- Section 7
-
- Failure to complete this section or mark that it is not applicable
- If section is completed, ensure the Home Office fee-for-service
contractor and Home Office Chain number is listed.
- If section is completed, need to include additional 4 digits in
the zip code.
- Section 8
-
- Failure to complete this section or mark that it is not applicable
- If completed, ensure a copy of the billing agreement is attached
and enter an effective date.
- If completed, need to include additional 4 digits in the zip code
- Section 12
-
- Failure to mark the box that indicates that this section does not
apply if the section is not completed.
- Section 15
-
- Signature and dates in this section are not an original signature.
Do not submit copies or stamped signature. Use blue ink to authenticate
signature.
- This section should be signed and dated by an officer, owner or
partner of the facility, not a managing employee.
- A section 6 must be completed on the individual signing this section
of the application.
- The person signing is not officer, partner, or owner of the applicant/facility
but is an officer or partner of an owning or parent company.
- Section 16
-
- Application does not have an original signature and date
- Person signing this section must also have a section 6
- Person signing this section must be an officer, partner, or owner
of the applicant but not of an owning or parent company.
- The person has indicated in Section 6 that they are a contracted
managing employee. Delegated officials must be W-2 employees.
- Missing Documentation
-
- IRS verification of the TIN reported in Sections 2B1, 5 or 7.
- EFT Agreement.
- Copy of adverse legal action documentation if applicable.
- Attestation from government entities that they are liable for any
debts owed to CMS when applicable.
- Copy of the final bill of sale or sales agreement with all exhibits
referenced in the agreement for a change of ownership.
- The names/entities on the bill of sales or sales agreement do not
match the names on the old and new owner CHOW 855As.
- Capitalization documentation was not submitted.
