CMS Pub. 100-08, ch. 10, § 10.6.8

A billing agency is an entity or person that furnishes billing and collection services on behalf of a

provider/supplier. A billing agency does not enroll in the Medicare program; rather, it submits

claims to Medicare in the name and billing number of the provider/supplier that furnished the

service(s). To receive payment directly from Medicare on a provider/supplier’s behalf, a billing

agency must meet the conditions described in § 1842(b)(6)(D) of the Social Security Act.

The provider/supplier shall complete the Billing Agency section of the Forms CMS-855A,

CMS-855B, CMS-855I, CMS-855S and CMS-20134 with information about all billing

agents it utilizes. (Note that the billing agency address can be listed as a PO Box on the

Form CMS-855 and CMS-20134 applications.) As all Medicare payments must be made via

electronic funds transfer, the contractor need not verify the provider’s compliance with the

“Payment to Agent” rules in CMS Pub. 100-04, chapter 1, section 30.2. The only exception

is if the contractor discovers that the “special payments” address in the Practice Location

section of the provider’s Form CMS-855 or CMS-20134 application belongs to the billing

agent or agency. In this situation, the contractor may obtain a copy of the billing agreement

if it has reason to believe that the arrangement violates the “Payment to Agent” rules.

For further information on billing agencies, see CMS Pub. 100-04, chapter 1, section 30.2.4.