Get Cms Final Settlement Detail Document

Filling out the Cms Final Settlement Detail Document accurately is crucial for ensuring proper interactions with Medicare regarding settlements. This guide provides clear, step-by-step instructions on how to complete the form online to facilitate effective communication and compliance.

Follow the steps to complete the form with ease.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the beneficiary's name in the designated field. Ensure that the name matches the records associated with their Medicare number.
3. Input the Medicare number exactly as it appears on the beneficiary's Medicare card to avoid discrepancies.
4. Provide the date of the incident related to the settlement. Use the format MM/DD/YYYY for clarity.
5. Fill in the total amount of the settlement received by the beneficiary. This should represent the total settlement before any deductions.
6. Enter the total amount of Med-Pay or Personal Injury Protection (PIP) received if applicable. This amount should reflect any supplementary insurance payments.
7. Input the attorney fee amount paid by the beneficiary. This helps Medicare account for expenses incurred during the settlement process.
8. Detail any additional procurement expenses paid by the beneficiary in the specified field. Be sure to submit an itemized listing of these expenses as instructed.
9. Record the date when the case was settled using the same MM/DD/YYYY format.
10. Once all fields are completed, review the form for accuracy. After confirming all information is correct, you can save your changes, download a copy, or print it for submission.
11. Submit the completed form along with a copy of the accompanying notice to the Benefits Coordination & Recovery Center at the provided address.

Complete and submit your Cms Final Settlement Detail Document online today for a smooth process.