You won’t need to file a separate 855A enrollment application for a new location in another state if a set of five specific conditions is met, CMS says in a new transmittal dated Oct. 19.

The conditions are as follows:

  • The location is not part of a separate organization;
  • The location doesn’t have a separate tax identification number (TIN) and legal business name (LBN);
  • The state in which you plan to open the new location doesn’t require it to be surveyed;
  • The applicable CMS regional office doesn’t require the new location or its owner to sign a separate provider agreement; AND
  • The location isn’t a federally qualified health center.

In all other cases, a separate, initial form 855A must be filed for the new location, the transmittal states.

The transmittal also codifies final regulations CMS published in April, which state that:

  • Providers who refer patients for home health services must be enrolled in the provider enrollment, chain and ownership system (PECOS) or the corresponding legacy system. CMS has long said that home health claims which lack a PECOS-enrolled referring physician will be denied, but no date has been set for the denials to begin.
  • Residents may enroll in Medicare to order and refer services if state regulations allow them to perform those tasks.

CMS also adds some new instructions on changes of ownership, but prefaces the section by saying that the changes don’t apply to home health agencies.

Another clarification: Providers may list a “generic” email address on their enrollment application, CMS states. Even if the address doesn’t clearly belong to a specific individual, contractors will accept it unless they have a specific reason to believe the address isn’t affiliated with the provider, the instruction adds.

The transmittal will update chapter 15 of the Program Integrity Manual effective Nov. 20.