Get Rem-517

The REM-517 form is essential for attesting to provider-based compliance in healthcare settings. This guide provides an easy-to-follow process for filling out the form online, ensuring that users can navigate its components with confidence.

Follow the steps to complete the REM-517 efficiently.

1. Click ‘Get Form’ button to obtain the REM-517 and open it in the editor.
2. Fill in the main provider’s Medicare PTAN/CCN in the designated field, ensuring that both PTAN and CCN are consistent.
3. Input the main provider’s National Provider Identifier (NPI) in the corresponding section.
4. Enter the main provider’s name as it appears in the business records.
5. Provide the main provider’s address, making sure to include all necessary details.
6. Complete the contact information for the attestation contact, including the name, phone number, and email address.
7. Include the name and exact address of the provider-based facility or organization, ensuring accuracy for compliance.
8. Indicate the date when the facility/organization became provider-based with the main provider.
9. If applicable, fill in the facility/organization’s Medicare PTAN and NPI.
10. Answer the question regarding whether the facility is part of a multi-campus hospital.
11. Indicate whether the main provider is accredited and by which accrediting body.
12. Select the appropriate options regarding the main provider's status as a critical access hospital (CAH) and certify the necessary information regarding location requirements.
13. Choose between options A or B, confirming compliance with the requirements as stated.
14. List the types of services provided at the facility by checking all relevant options.
15. Verify compliance with additional provider-based requirements listed and answer yes or no as applicable.
16. Finally, review all filled-in sections for accuracy and clarity before saving changes, downloading, printing, or sharing the completed form.

Complete your REM-517 form online today for a seamless filing experience!