ANY change to information on the Medicare CMS-855 enrollment form must be reported.
For example —
Mailing address
Practice location
Adverse legal action
Changes in ownership –typically asset sales or mergers/consolidations
Changes in direct/indirect owners of 5% or more (but not a CHOW) or changes in managing control
Special payment address
Medical Record Storage Location
Billing Agency Info
Special HHA Info (Surety Bonds)
Authorized representative & Delegated Officials
For DME –change in supplier type, products/services, accreditation, insurance
