Get Cms Exhibit 286

Filling out the Cms Exhibit 286, also known as the Hospital/CAH Medicare Database Worksheet, is essential for gathering accurate data about healthcare facilities. This guide provides clear, step-by-step instructions to help users complete the form effectively, ensuring compliance with Medicare requirements.

Follow the steps to complete the Cms Exhibit 286 successfully

1. Click the ‘Get Form’ button to access the Cms Exhibit 286 and download the form to your device.
2. Begin filling out the top section of the form, starting with the CMS Certification Number (CCN) and the date of worksheet update. Ensure you enter the correct format (MMDDYYYY) where indicated.
3. Enter the Medicaid Provider Number and National Provider Identification Number(s) (NPI) accurately, paying attention to any formatting requirements.
4. Fill in the fiscal year ending date, facility name, and complete address including city, state, and zip code. Provide the primary telephone number, fax number, CEO telephone number, email address, and website address.
5. Select the accreditation status by marking the appropriate box and fill out the effective and renewal dates of accreditation. Ensure that multiple accreditation statuses are noted if applicable.
6. Complete the state/county code, state region code, and type of program participation section, selecting the most appropriate options.
7. For the Medicare CAH status or type of Medicare hospital, mark the option that best describes your facility.
8. Indicate whether there is an affiliation with a medical school and if resident programs exist, marking all that apply.
9. In the ownership type section, select the most suitable option for your institution. Fill out details regarding the average daily census and the number of staffed beds.
10. Continue filling out the sections related to chain/health system involvement, total number of employees, and Medicare payment-related categories for the hospital or CAH.
11. In the services provided section, indicate the services your facility offers by checking the appropriate boxes.
12. Complete additional sections concerning off-site locations and affiliated providers/suppliers, using the provided worksheets as necessary.
13. Once finished, review all entries for accuracy and completeness, then save changes. You may download, print, or share the completed form as needed.

Begin filling out your Cms Exhibit 286 online and ensure your healthcare facility complies with Medicare standards.