CMS Pub. 100-04, ch. 1, § 30.2.6

B3-3060.1

The carrier may pay Part B benefits for covered physician services under an assignment

or for enrollees that did not execute assignment before death to the physician’s employer,

provided that under the terms of the physician’s employment, only the employer and not

the physician has the right to charge or collect charges for the physician’s services, and

certain other conditions and limitations described below are met. There must be an

employer-employee relationship between the physician and the person or organization

hiring the physician to perform services, and the terms of the employment must provide

that the employer and not the physician has the right to receive the payment for all the

latter’s services within the scope of the employment. If the employer has the right, as a

condition of employment, to fees for all professional services the physician renders,

including those outside the scope of the employment, honor an assignment of benefits to

the employer for all such services.

An employer may establish that it qualifies to receive payment for the services of its

physicians by submitting the Form CMS-855R.

The employer must provide evidence that the employee is a valid employee by providing

the carrier with a Form W-2 or other acceptable Internal Revenue Service documentation

(a pay stub would suffice for new employees who do not yet have a Form W-2.).