Loading
Get Cms-417 2010
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the CMS-417 online
The CMS-417 form is crucial for obtaining or retaining Medicare benefits for hospice services. This guide provides step-by-step instructions on how to accurately complete the form online, ensuring you submit all necessary information correctly.
Follow the steps to complete the CMS-417 form online.
- Press the ‘Get Form’ button to access the CMS-417 form and open it within your preferred editor.
- In Item I, enter the name of the hospice facility and the street address. For 'Request to Establish Eligibility In', indicate that you are applying for Medicare benefits.
- Insert the facility’s six-digit Medicare Certification Number where specified. If this is your initial request for certification, you may leave this field blank.
- Leave the State/County and State/Region Codes blank, as these will be completed by the Centers for Medicare & Medicaid Services Regional Office.
- If applicable, provide the related certification number if your hospice is affiliated with another Medicare provider.
- In Item IV, indicate whether services are provided directly by the facility (by placing a '1') or through an outside source (by placing a '2') in the respective block.
- Complete the section regarding the type of control by selecting one of the provided options, such as Proprietary, Government, Non-Profit, etc.
- Fill out the telephone number and ensure that all required fields about services rendered are accurately completed.
- Once all sections are filled in, review your entries for accuracy and completeness.
- Finally, save your changes, and if necessary, download, print, or securely share the completed form as required.
Complete the CMS-417 form online today to ensure timely processing of your Medicare certification request.
Get form
Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
Related links form
A CMS number refers to a unique identifier assigned to healthcare providers and facilities by the Centers for Medicare & Medicaid Services. This number is essential for billing and tracking services provided under their programs. To understand the application of your CMS-417 and its importance, consider utilizing resources from US Legal Forms.
Get This Form Now!
Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.