My partner’s wife is taking over a practice which has an active DME number with the contact person as the original owner. How difficult is it for her to change the contact person and supplier to herself? Will she be required to submit an entirely new DME application even though the tax ID of the practice will remain the same?
A CMS-855S needs to be completed to submit Change of Information.
“Change of Information Other Than Adding a New Location
If you are adding, deleting, or changing information under your current Medicare supplier billing number. Any change to your existing enrollment data must be reported within 30 days of the effective date of the change.”
For Change of Ownership and/or Managing Control there is a section that should be selected.
It directs the supplier as to what sections in the application must be completed:
“Ownership and/or Managing Control Information (Individuals)
1C, 2A1, 3, 6, 13, and either 15 (if you are the authorized official) or 16 (if you are the delegated official), and 6 for the signer if that authorized or delegated official has not been established for this DMEPOS supplier.”
There are a couple things that they should know in completing the form:
Section 2.A.1 – Supplier Identification
This information should identically match the current information that is on file with the National Supplier Clearinghouse.
If it is an Organization, chances are that the same DMEPOS PTAN may be kept.
If the current supplier is a Sole Proprietor, using an EIN with a DBA, chances are that the new supplier will get a new number.
Section 3 – Final Adverse Legal Actions/Convictions
This section MUST be answered “Yes” or “No”.
If the answer is Yes, then “Yes” should be checked and details listed.
If the answer is “No” then they should check off “No” and continue on to the next section.
Section 6 – Ownership Interest and/or Managing Control Information (Individuals)
This page is used to identify the new owner as being added and should be completed in its’ entirety.
New individual information should be added.
Exiting individual should be “Deleted”
PLEASE NOTE: This page needs to be submitted for each individual. Make copies of this page as needed.
Section 13 – Contact Person
It is always suggested to have someone, other than the supplier, as an additional contact person in case there are questions.
Section 15 – Certification Statement
The application must be signed. Copies or stamps are not acceptable.
Section 17 – Supporting Documents
Copy of your bill of sale if you purchased an existing DMEPOS supplier with an active Medicare supplier billing number.
Please let me know if I can be of further assistance.