Terms of the previous clearance remain in effect. OMB files this comment in accordance with
5 CFR 1320.11( c ). This OMB action is not an
approval to conduct or sponsor an information collection under the Paperwork Reduction Act
of 1995. This action has no effect on any current approvals. If OMB has assigned this ICR a
new OMB Control Number, the OMB Control Number will not appear in the active inventory.
For future submissions of this information collection, reference the OMB Control Number
provided. OMB is withholding approval at this time. Prior to publication of the final rule, the
agency should provide a summary of any comments related to the information collection and
their response, including any changes made to the ICR as a result of comments. In addition,
the agency must enter the correct burden estimates.
Inventory as of this Action
Requested
Previously Approved
01/31/2020
36 Months From Approved
01/31/2020
515,200
0
515,200
243,600
0
243,600
0
0
0
The publication of the Patient Protection and Affordable Care Act (PPACA), section 6405 - "Physicians Who Order Items or Services Required to be Medicare Enrolled Physicians or Eligible Professionals" (regulation CMS 6010-F), contains a requirement for certain physicians and non-physician practitioners to enroll in the Medicare program for the sole purpose of ordering or referring items or services for Medicare beneficiaries. The PPACA has an effective date applicable to written orders and certifications made on or after July 1, 2010. The CMS 855O allows a physician to receive a Medicare identification number (without being approved for billing privileges) for the sole purpose of ordering and referring Medicare beneficiaries to Medicare approved providers and suppliers. This new Medicare application form allows physicians who do not provide services to Medicare beneficiaries to be given a Medicare identification number without having to supply all the data required for the submission of Medicare claims. It also allows the Medicare program to identify ordering and referring physicians without having to validate the amount of data necessary to determine claims payment eligibility (such as banking information), while continuing to identify the physician's credentials as valid for ordering and referring purposes.
CMS-4182-P rescinds the Part D enrollment requirements in 42 CFR 423.120, therefore, all references to Part D enrollment for prescribers of Part D drugs have been eliminated from this PRA package and the CMS-855O Medicare Application Form.
Burden associated with the Changes of Enrollment Information and Reporting a Voluntary Withdrawal are unchanged by the proposed rule. As demonstrated in the following table, we have revised our burden estimates associated with Initial Enrollment Application by -420,000 respondents/responses (515,200 – 95,200) and -210,000 hours (243,600 – 33,600).
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Form CMS-855O Reporting Voluntary Withdrawal of Registration Information
CMS 855O - Revisons Spreadsheet - 11202017.pdf
CMS-855O - Supporting Statement A 11-28-2017 OSORA PRA Input - KM AB Responses - 12062017.docx
Reporting Voluntary Withdrawal of Registration Information