CMS-855R Version (1/20) Reassignment of Medicare Benefits

As a reminder, effective 5/1/2020, the CMS-855R Version (1/20) is the only version of the CMS-855R that can be submitted to allow a provider to reassign benefits to an organization/group or individual practitioner or to terminate a reassignment from an organization/group or individual practitioner.

• Section 2 on the new form is to be completed with the information of the billing entity for the rendering provider which can be either A. Organization/Group Identification or B. Individual Practitioner Identification.
• Section 3 should be completed with information for the Individual Practitioner Who is Reassigning Benefits to either the organization/group or the individual practitioner identified in Section 2.

Please refer to the Job Aid CMS-855R (01/20) Reassignment of Medicare Benefits Completion Tips for Physicians and NPPs that Reassign Some or All Benefits as a reference.

Posted 8/28/2020