Get Cms-700 1991-2025

The CMS-700 form is crucial for outlining treatment plans for outpatient rehabilitation services. This guide provides clear steps and insights on how to accurately complete the form online, ensuring compliance and clarity in your documentation.

Follow the steps to effectively fill out the CMS-700 online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the patient's last name, first name, and middle initial as it appears on the health insurance Medicare card.
3. Input the Medicare provider number assigned to the billing provider.
4. Fill in the health insurance claim number (HICN) as shown on the patient’s Medicare card or other official documents.
5. Provide the name of the Medicare billing provider responsible for the treatment.
6. If applicable, enter the patient’s medical record number used by the billing provider.
7. Record the onset date of the patient's primary medical diagnosis or the date of the most recent exacerbation.
8. Specify the start of care (SOC) date, which is the date services began.
9. Select the type of therapy being billed, such as physical therapy, occupational therapy, or others.
10. Document the primary diagnosis related to the therapy and any treatment diagnosis as needed.
11. List the total visits completed since the start of care for the treatment.
12. Outline the current plan of treatment and the short-term goals, ensuring clarity on long-term outcomes.
13. Provide the signature and professional designation of the individual establishing the plan of treatment.
14. Detail the frequency and duration of treatment sessions, such as '3/Wk x 4Wk'.
15. If certification is required, obtain the physician’s signature.
16. Indicate the date of the physician’s signature if certification is necessary.
17. State the inclusive dates of certification related to the treatment plan.
18. If certification is on file, type the physician’s name who certified the plan.
19. List any relevant prior hospitalization dates affecting the treatment.
20. Include a summary of the initial assessment relevant to the patient's current treatment.
21. Document the patient’s functional level and progress at the end of the billing period.
22. Input the service dates, indicating the billing period accurately.

Start filling out the CMS-700 form online to ensure a comprehensive plan of treatment.