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[Federal Register Volume 77, Number 65 (Wednesday, April 4, 2012)]
[Notices]
[Pages 20402-20403]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-8010]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-855(O)]

Agency Information Collection Activities: Submission for OMB 
Review; Comment Request

AGENCY: Centers for Medicare & Medicaid Services, HHS.

    In compliance with the requirement of section 3506(c)(2)(A) of the 
Paperwork Reduction Act of 1995, the Centers for Medicare & Medicaid 
Services (CMS), Department of Health and Human Services, is publishing 
the following summary of proposed collections for public comment. 
Interested persons are invited to send comments regarding this burden 
estimate or any other aspect of this collection of information, 
including any of the following subjects: (1) The necessity and utility 
of the proposed information collection for the proper performance of 
the Agency's function; (2) the accuracy of the estimated burden; (3) 
ways to enhance the quality, utility, and clarity of the information to 
be collected; and (4) the use of automated collection techniques or 
other forms of information technology to minimize the information 
collection burden.
    1. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Medicare 
Registration Application; Use: 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 registration 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. Since the physicians and non-physician 
practitioners submitting this application are not enrolling in Medicare 
to submit claims but are only registering with Medicare as eligible to 
order and refer, CMS believes changing the title from Medicare 
Enrollment Application to Medicare Registration Application better 
captures the actual purpose of this form.
    Where appropriate, CMS has changed all references to enrollment or 
enrolling to registration and registering and Medicare billing number 
to National Provider Identifier. CMS also added a check box to allow 
physicians and non-physician practitioners to withdraw from the 
ordering and referring registry. A section to collect information on 
professional certifications was added for those practitioners who are 
not professionally licensed. Editorial and formatting corrections were 
made in response to prior comments received during the approval of the 
current version of this application. Other minor editorial and 
formatting corrections were made to better clarify the purpose of this 
application. Form Number: CMS-855(O) (OCN: 0938-1135); Frequency: 
Occasionally; Affected Public: Individuals; Number of Respondents: 
48,500; Total Annual Responses: 48,500; Total Annual Hours: 24,125. 
(For policy questions regarding this collection contact Kimberly 
McPhillips at 410-786-5374. For all other issues call 410-786-1326.)
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of

[[Page 20403]]

Information Collection: Medicare Enrollment Application; Use: The 
primary function of the CMS-855 Medicare enrollment application is to 
gather information from a provider or supplier that tells us who it is, 
whether it meets certain qualifications to be a health care provider or 
supplier, where it practices or renders its services, the identity of 
the owners of the enrolling entity, and other information necessary to 
establish correct claims payments. Form Number: CMS-855(A, B, I, R) 
(OCN: 0938-0685); Frequency: Yearly; Affected Public: Private Sector; 
Business or other for-profit and not-for-profit institutions; Number of 
Respondents: 440,450; Total Annual Responses: 440,450; Total Annual 
Hours: 856,395. (For policy questions regarding this contact Kim 
McPhillips at 410-786-5374. For all other issues call 410-786-1326.)
    To obtain copies of the supporting statement and any related forms 
for the proposed paperwork collections referenced above, access CMS Web 
Site address at http://www.cms.hhs.gov/PaperworkReductionActof1995, or 
Email your request, including your address, phone number, OMB number, 
and CMS document identifier, to Paperwork@cms.hhs.gov, or call the 
Reports Clearance Office on (410) 786-1326.
    To be assured consideration, comments and recommendations for the 
proposed information collections must be received by the OMB desk 
officer at the address below, no later than 5 p.m. on May 4, 2012.

OMB, Office of Information and Regulatory Affairs, Attention: CMS Desk 
Officer, Fax Number: (202) 395-6974, Email: OIRA_submission@omb.eop.gov.

    Dated: March 28, 2012.
Martique Jones,
Director, Regulations Development Group, Division B, Office of 
Strategic Operations and Regulatory Affairs.
[FR Doc. 2012-8010 Filed 4-3-12; 8:45 am]
BILLING CODE 4120-01-P
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