Sunday, August 28, 2016

What form used for change of ownership

 Change of Ownership

When an organization having a provider agreement undergoes a change of ownership in accordance with the principles articulated in 42 CFR Part 489 and §3210 of the State Operations Manual, the agreement with the existing provider is automatically assigned to the new owner so that there is no interruption in service. However, a new agreement with updated information must subsequently be signed and a Form CMS-855A must be submitted by both the old and new owners. Only if the provider, under the change of ownership, meets the applicable requirements for approval can the agreement be executed. For FQHCs, these requirements include PHS approval.

An organization that plans to change ownership must give advance notice of its intention so that a new agreement can be negotiated or so that the public may be given sufficient notice in the event that the new owners do not wish to participate in the Medicare program. A provider that plans to enter into a lease arrangement (in whole or in part) should also give advance notice of its intention.

A change of ownership occurs, for example, when:

• A sole proprietor transfers title and property to another party;

• In the case of a partnership, there is an addition, removal, or substitution of a partner unless the partners expressly agree otherwise;

• An incorporated organization merges with an incorporated entity that is approved by the program and the latter entity is the surviving corporation. It also occurs when two or more corporate providers consolidate and the consolidation results in the creation of a new corporate entity;

• An unincorporated organization (a sole proprietorship or partnership) becomes incorporated; or

• The lease of all or part of an entity constitutes a change of ownership of the leased portion.

When an organization’s agreement is terminated, whether by the entity or by CMS, no payment is available to the provider for services it furnishes to Medicare beneficiaries on or after the effective date of the termination.


When a change in facility ownership occurs during a beneficiary's inpatient stay, two claims must be submitted (one by each provider). The first owner is entitled to payment for the day of transfer.

** The first claim must show the appropriate patient status code and a "through" date equal to the last day of original ownership.

** The second claim must show the "from" date as the first day of the new ownership.

** The same admission date must be used on both claims.

** If a PACER number was required for the admission, both claims must use the same PACER number.

** "Change in ownership" must be stated in the remarks section on the second claim.


If a facility changes ownership, the facility must register the NPI for the new owner through the on-line CHAMPS Provider Enrollment (PE) subsystem. If the provider tax identification number (TIN) did not change, the NPI can be reported through the CHAMPS PE maintenance function. If the change involves a new TIN, the provider must complete a new enrollment application. (Refer to the Provider Enrollment Section of the General Information for Providers Chapter for enrollment information.) If the facility changes ownership in the middle of the month and the beneficiary was in continuous residency at the facility for the month, the facility must submit a claim using the old provider NPI number for the first part of the month and another claim for the second part of the month using the new provider NPI number. The process for two facilities and two claims in a month should be followed for beneficiaries with patient-pay amounts. (Refer to the Patient-Pay Amount subsection above for additional information.)

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