Helpful Tips

CMS-855I Completion Tips for Managing Employee Information in Section 6

Section 6: Managing Employee Information

This section captures information about your managing employees. A managing employee means an individual who furnishes operational or managerial services, or who directly or indirectly conducts the day-to-day operations for your private practice, either as an employee or through some other arrangement. All managing employees at all of your practice locations reported in section 4 must be reported in this section.

If you completed section 4 reporting that your private practice is established as a business entity, you must report at least one managing employee in accordance with Medicare policy for enrolling a business entity.

Instructions for Completing Section 6

Check box or complete section 6A and 6B.

❒ I am the managing employee. Skip to section 8.

Section 6A ‒ Managing Employee Identifying Information

  • Complete section with the identifying information of each individual managing employee.
  • Indicate if action is a change, add or remove and furnish effective date.

Each individual listed in Section 6A must have a Section 6B.  Report any final adverse legal action imposed against individual identified in section 6A. 

Section 6B ‒ Final Adverse Legal Action History

  • Question 1 must be answered by selecting Yes or No.
  • If yes, report details in Questions 2 and submit a copy of the adverse legal action documentations and resolutions.

Updated 3/12/2019