Get Provider-based Status, Under Arrangements, Enrollment And ... - Healthlawyers

This guide aims to provide clear and comprehensive instructions on how to fill out the Provider-Based Status, Under Arrangements, Enrollment And ... - Healthlawyers form online. Understanding the requirements and steps for completion can facilitate your navigation of this important documentation.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to access the form and open it in your form editor.
2. Begin filling out the first section by providing accurate information about the provider's name and address. Ensure that all details are current and match official records.
3. Next, indicate the type of provider-based facility you are representing. Choose from options such as a hospital outpatient department, skilled nursing facility, or rural health clinic as appropriate.
4. In the sections regarding Medicare and Medicaid status, carefully review and enter any necessary information about compliance with provider-based status requirements codified at 42 C.F.R. § 413.65.
5. Complete the financial information section, detailing the integration of the facility's financial operations with the main provider’s financial systems.
6. Review the obligations of the hospital outpatient departments as outlined in the regulations to ensure all requirements are being met. This includes EMTALA obligations and supervision standards.
7. Once all fields are filled out accurately, review the form for completeness and correctness.
8. Finally, save your changes, and consider options to download, print, or share the form as necessary for your records.

Take the next steps in managing your provider-based facility by completing the required documentation online.