Withdraw from Medicare - JF Part B

We are sorry to see you go. When a physician or non-physician practitioner retires, surrenders his or her license for any reason, or chooses to no longer participate in the Medicare program, he/she should voluntarily withdraw from the Medicare program. Withdrawing from Medicare is considered a change, and should be reported within 90 days.

Failure to deactivate PTANs no longer in use could result in:

• Revocation
• Fraudulent billing

CMS has established Internet-based Provider Enrollment, Chain and Ownership System (PECOS) as an alternative to the paper (CMS-855) enrollment process. Internet-based PECOS will allow physicians, non-physician practitioners and provider and supplier organizations to enroll, make a change in their Medicare enrollment, view their Medicare enrollment information on file with Medicare, or check status of a Medicare enrollment application via the Internet.

View the CMS Internet-based PECOS webpage for more information.

Withdrawing from Medicare?

If you are no longer associated with a group or billing Medicare, submit the appropriate application to terminate the PTAN.

• Providers/Organizations terminating a reassignment of benefits submit the CMS-855I.
• Providers terminating a solo practice submit the CMS-855I.
• Physician Assistants terminating employment with an organization submit the CMS-855I
• Organizations terminating employment with a physician assistant submit the CMS-855B.
• Organizations terminating their practice submit the CMS-855B.

View our Enrollment on Demand Application Tutorials for proper submission.

Termination Scenarios

• Ending one Reassignment to an organization, while maintaining another Reassignment to the same organization
• Ending one reassignment to organization, while maintaining a different reassignment to a different organization
• Ending employment with an organization
• Completely withdrawing from the Medicare program
• Ending a Practice Location
• Moving from one state to another
• Switching from reassigning benefits to being the Sole Owner of your corporation, etc.

If you receive notification about the other states the provider is enrolled in, and the provider is no longer working in those other states, submit an application to withdraw from those states. If the provider is still rendering services in those states, disregard. Note the possible consequences above for failure to deactivate PTANs.

Tips

• Only one signer is needed for termination of a reassignment
• Terminate using Internet-Based PECOS Web for faster processing time