CMS Pub. 100-08, ch. 10, § 10.6.17

A. Reports of Death from the Social Security Administration (SSA)

Contractors, including DME MACs, will receive from CMS a monthly file that lists individuals

who have been reported as deceased to the SSA. To help ensure that Medicare maintains current

enrollment and payment information and to prevent others from utilizing the enrollment data of

deceased individuals, the contractor shall undertake the activities in this section 10.6.17.

B. Erroneous Report of Death

In the event of an erroneous report of death, the contractor shall contact its PEOG BFL for

guidance.

C. Verification Activities for Individuals Other than Physicians, Non-Physician

Practitioners, and/or DMEPOS Suppliers

(If the person is an owner, sole owner of a professional corporation or professional association,

managing employee, director, officer, authorized official, etc., the contractor shall verify and

document in PECOS that the person is deceased using the process described in section

10.6.17(D)(1).)

Once the contractor verifies the report of death, it shall notify the provider or supplier

organization with which the individual is associated that it needs to submit a Form CMS-855

change request that deletes the individual from the provider or supplier’s enrollment record. If

the provider fails to submit this information within 90 calendar days of the contractor’s request,

the contractor shall deactivate the provider’s Medicare billing privileges in accordance with 42

CFR § 424.540(a)(2). (For DMEPOS Suppliers - If a DMEPOS supplier fails to submit this

information within 30 calendar days of the contractor’s request, the contractor shall deactivate

the supplier’s billing privileges in accordance with 42 CFR § 424.57(c)(2).) The contractor

need not, however, solicit a Form CMS-855 change request if the organization is enrolled with

another contractor. Instead, the contractor shall notify (via fax or e-mail) the contractor with

which the organization is enrolled of the situation, at which time the latter contractor shall take

actions consistent with this section 10.6.17.

D. Reports of Death from Third-Parties

1. Verification of Death

If a contractor (including DME MACs) receives a report of death from a third-party (e.g., state

provider association, state medical society, academic medical institution, etc.), the contractor

shall verify that the physician, non-physician practitioner, or DMEPOS supplier is deceased by:

• Obtaining oral or written confirmation of the death from an authorized or delegated official

of the group practice to which the physician, non-physician practitioner or DMEPOS supplier

had reassigned benefits;

• Obtaining an obituary notice from the newspaper;

• Obtaining oral or written confirmation from the state licensing board (e.g., telephone, e-mail,

computer screen printout);

• Obtaining oral or written confirmation from the State Bureau of Vital Statistics; or

• Obtaining a death certificate, Form SSA-704, or Form SSA-721 (Statement of Funeral

Director).

All verification shall be documented in PECOS per section 10.6.19(I) (and, as applicable, section

10.3) of this chapter; in addition, any documents that were used to confirm the death (e.g.,

obituary notice) shall be uploaded into PECOS.

2. Deceased Individuals: Post-Confirmation Actions

Once the contractor verifies the death, it shall:

a. Undertake all actions normally associated with the deactivation of a supplier’s billing

privileges.

b. Search PECOS to determine whether the individual is listed therein as an owner, managing

employee, director, officer, partner, authorized official, or delegated official of another supplier.

c. If the person is not in PECOS, no further action with respect to that individual is needed.

d. If the supplier is indeed identified in PECOS as an owner, sole owner of a professional

corporation or professional association, officer, etc., the contractor shall notify the organization

with which the person is associated that it needs to submit a Form CMS-855 change request that

deletes the individual from the entity’s enrollment record. If a provider fails to submit this

information within 90 calendar days of the contractor’s request, the contractor shall deactivate

the provider’s billing privileges in accordance with § 424.540(a)(2). (For DMEPOS Suppliers -

If a DMEPOS supplier fails to submit this information within 30 calendar days of the

contractor’s request, the contractor shall deactivate the supplier’s billing privileges in accordance

with § 424.57(c)(2).) The contractor need not, however, ask for a Form CMS-855 change

request if the organization is enrolled with another contractor. Instead, the contractor shall notify

(via fax or e-mail) the contractor with which the organization is enrolled of the situation, at

which time the latter contractor shall take actions consistent with this section 10.6.17.

E. Deceased Individuals: Education & Outreach

Contractors (including DME MACs) shall conduct outreach to state provider associations, state

medical societies, academic medical institution, and group practices, etc., regarding the need to

promptly inform contractors of the death of physicians and non-physician practitioners

participating in the Medicare program.

F. Process to Deactivate NPI Due to a Death

1. Trustees/Legal Representatives

The trustee/legal representative of a deceased physician, non-physician practitioner, or DMEPOS

supplier’s estate may deactivate the NPI of the deceased provider by providing written

documentation to the NPI enumerator.

2. Special Payment Address: Process to Update to an Estate Upon a Death

In situations where a physician, non-physician practitioner, or DMEPOS supplier has died, the

contractor can make payments to the individual’s estate per the instructions in Pub. 100-04,

chapter 1. When the contractor receives a request from the trustee or other legally-recognized

representative of the physician, non-physician practitioner, or DMEPOS supplier’s estate to

change the deceased’s special payment address, the contractor shall, at a minimum, ensure that

the following information is furnished:

• Form CMS-855 change of information request that updates the “Special Payment” address in

the application. The Form CMS-855 can be signed by the trustee/legal representative.

• Any evidence – within reason - verifying that the physician, non-physician practitioner, or

DMEPOS supplier is in fact deceased.

• Legal documentation verifying that the trustee/legal representative has the legal authority to

act on behalf of the provider, non-physician practitioner, or DMEPOS supplier’s estate.

The policies in this section 10.6.17(F) and (G) apply only to physicians, non-physician

practitioners. and DMEPOS suppliers who operated their business as sole proprietors. It does

not apply to solely-owned corporations, limited liability companies, etc., nor to situations in

which the physician or non-physician practitioner reassigned benefits to another entity.

All verification shall be documented in PECOS per section 10.6.19(I) of this chapter; in addition,

any documents that were used to confirm the death (e.g., obituary notice) shall be uploaded into

PECOS.

G. Other Enrollment Information

1. Reassignment and Revoked/Deceased Physicians and Non-Physician Practitioners

There are situations where a physician/non-physician practitioner (the “owning

physician/practitioner”) owns 100% of a practice, employs another physician (the “employed

physician/practitioner”) to work with the employing physician/non-physician practitioner, and

accepts reassigned benefits from the employed physician/practitioner. Should the sole proprietor

or sole owner die or have billing privileges revoked and the provider/supplier fails to submit an

updated Form CMS-855 within 90 days, the practice is automatically dissolved for purposes of

Medicare enrollment and all reassignments to the practice are automatically terminated as well.

Neither the owning physician/practitioner nor the practice is enrolled in Medicare any longer and

the enrollments for both shall be deactivated in accordance with the deactivation procedures

outlined in this chapter. (It is immaterial whether the practice was established as a sole

proprietorship, a professional corporation, a professional association, or a solely-owned limited

liability company.) In addition, the contractor shall end-date the reassignment using, as

applicable, the date of death or the effective date of the revocation.

Besides deactivating the enrollments of the owning physician/practitioner and the practice, the

contractor shall notify the employed physician/practitioner that:

a. The practice’s billing privileges have been deactivated;

b. Any services furnished by the physician/practitioner on behalf of the practice after the date of

the owning physician/practitioner’s death or date of revocation or deactivation will not be paid;

and

c. If the employed physician/practitioner wishes to provide services at the former practice’s

location, the individual must submit a Form CMS-855I change of information request to add the

owning physician/practitioner’s practice location as a new location of the employed

physician/practitioner. For purposes of this section 10.6.17(G)(1)(c) only, submission of an

initial Form CMS-855I and a terminating Form CMS-855R application are not required – even if

the employed physician/non-physician practitioner had reassigned all benefits to the practice.

H. Proof of Life Documentation

On rare occasions, erroneous death information may be received through the DMF process that

results in systematic enrollment deactivations in PECOS or records populated on the Deceased

Associates reports in PECOS for contractor deactivation actions. In order for the

providers/suppliers to reactivate their enrollments and have the date of death removed from their

PECOS records, the contractor shall request documentation that supports “proof of life” (for

example, Retirement, Survivors, and Disability Insurance document issued by SSA). If the

provider/supplier is unable to obtain such documentation, the contractor shall submit a request to

its PEOG BFL containing the provider/supplier’s name, date of birth, and SSN so that CMS can

confirm proof of life with SSA.