Riverbend

Common Errors on the CMS 588-EFT Agreement

Part I

• The box is not checked to indicate that payments are going to the home office.

Part II

• The legal business name does not match that in Section 2B1 of the 855A.
• The name on the bank account does not match the name in Section 2B1 or 4A of the 855A.
• The NPI does not match that for the facility.
• The TIN does not match the one in Section 2B1 of the 855A or 7C if the payments are going to the home office.

Part III

• Bank account and/or routing numbers reported to do not match those on the supporting documentation.

Part IV

• The name and signature is not that of the authorized or delegated official reported in Section 15 or 16 of the 855A.

Missing Documentation

• No statement from the bank indicating that they waive the right to offset Medicare receivables to satisfy loans or secure lines of credit .
• No statement from the provider on their letterhead authorizing payments to be sent to the home office.