DRG Coding Advisor-HCFA considering changes to Form 855

All sections may be in for revision

The Health Care Financing Administration (HCFA) in Baltimore is considering making changes to all 18 sections of controversial Form 855 that providers must complete to participate in Medicare.

Sources at the Medical Group Management Association (MGMA) in Englewood, CO, who have seen an internal HCFA memo say HCFA is prepared to make changes to all 18 sections.

The form is considered too complicated and burdensome by many providers, and health care groups have been lobbying HCFA to simplify it.

What may change

While nothing is official yet, the changes being considered, according to the MGMA sources, include the following:

• Instructions would provide examples of how to enroll providers and suppliers for situations that have resulted in questions and problems in the past.

• Applicants would be given an overview of the enrollment process and a list of whether they are enrolled by a carrier or intermediary.

• Instructions for each section would be interspersed within the form itself, making it easier to keep track of what information goes where.

• Check-boxes would be provided to indicate when a section is not applicable.

• Requests for prior Medicare numbers would be removed.

• Requests concerning affiliated units, off-site clinics, etc., would be removed from section 1B.

• Prior practice information on organizations and individuals (section 7) would be eliminated, as would section 10 (parents and joint ventures).

• Applicants would have to provide information on contractors with whom they have conducted $25,000 worth of business or more during a year. Different limits may be set for larger providers.

• Information on surety bonds for an individual would be eliminated.

• The enrollee would be clearly defined as the "provider/supplier" and not the entity that employs the physician.

• Form 855 may be broken into three distinct forms: one for practitioners, one for facilities, and a third for suppliers of durable medical equipment, prosthetics, orthotics, and supplies.

• Applicants would be allowed to skip sections 11 (chain, organizational data) and 12 (contractor information).