The CMS 855A for Home Health and Hospice
Providers enrolling in the Medicare program are required to complete the CMS 855A in order to
obtain billing privileges. The CMS 855A Medicare Enrollment Application must also be completed whenever enrollment information needs to be added, deleted, or changed. Most importantly, information must be submitted in a timely fashion to maintain billing privileges.
In completing the 855A, providers are being asked to certify that they are in compliance with all applicable federal and state licensure requirements. This includes certifying that they do not employ or contract with individuals or entities that are excluded from the Medicare or Medicaid Program. More information on exclusions

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