Form Cms-855a - Medicare Enrollment Application - Institutional Providers Page 20
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54SECTION 4: PRACTICE LOCATION INFORMATION
(Continued)
must report all practice locations where the hospital provides services. Do not report separately
Hospitals
enrolled provider types such as skilled nursing facilities (SNFs), HHAs, RHCs, etc., even if these entities
are provider-based to the hospital. Suppose a hospital owns a SNF and an HHA. The hospital should not
list the SNF and HHA on its application, as they are not locations where the hospital furnishes services.
They are providers that are separate and distinct from the hospital, and will be reported on their respective
CMS-855A applications.
Base of Operations Address
• If this provider does not have a physical location where equipment and/or vehicles are stored or from
where personnel report on a regular basis, complete this section with information about the location
of the dispatcher/scheduler. This situation may occur if the provider operates mobile units that travel
continuously from one location directly to another.
• HHAs must complete this section.
Mobile Facility and/or Portable Units
To properly pay claims, Medicare must know when services are provided in a mobile facility or with
portable units. (This section is mostly applicable to providers that perform outpatient physical therapy,
occupational therapy, and speech pathology services.)
• A “mobile facility” is generally a mobile home, trailer, or other large vehicle that has been converted,
equipped, and licensed to render health care services. These vehicles usually travel to local shopping
centers or community centers to see and treat patients inside the vehicle.
• A “portable unit” is when the provider transports medical equipment to a fixed location (e.g., a
physician’s office or nursing home) to render services to the patient.
CMS-855A (07/11)
19
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