Get Cms-701 1991-2025

Filling out the CMS-701 form online is an essential step for managing outpatient rehabilitation claims. This guide will walk you through each section of the form to ensure a smooth and accurate completion.

Follow the steps to successfully complete the CMS-701 online.

1. Click ‘Get Form’ button to access the CMS-701 form in the online editor.
2. Begin by entering the patient's last name, first name, and middle initial in the designated fields.
3. Input the provider number issued by Medicare in the corresponding section.
4. Enter the patient's health insurance claim number (HICN) as it appears on their Medicare card.
5. Provide the name of the Medicare billing provider in the appropriate field.
6. If applicable, include the patient's optional medical record number.
7. Fill in the date of onset for the patient's primary medical diagnosis.
8. Specify the start of care (SOC) date to indicate when services began.
9. Indicate the type of therapy by checking the appropriate box (PT, OT, SLP, etc.).
10. List the primary diagnosis relating to the need for therapy and the treatment diagnosis if different.
11. Record the total number of visits the patient has completed since the start of care.
12. Describe the current frequency and duration of the treatment sessions.
13. Provide a current plan update, including functional goals for the billing period.
14. Complete the recertification section by noting the dates if necessary, or check the N/A box.
15. Sign the form in the physician's signature section if recertification is required.
16. Record the date of the physician's signature.
17. Print or type the physician's name who has certified the treatment plan, if applicable.
18. Clarify the reasons for continuing treatment during this billing period.
19. Enter the signature (or name) of the professional recommending care, along with their designation.
20. Indicate the date of the rehabilitation professional’s signature.
21. Check the box indicating whether services are continuing or being discontinued.
22. Document the patient's functional level at the end of the billing period.
23. Enter the service dates that represent the billing period accurately.
24. Finally, review the form, ensure all fields are completed, and either save changes, download, print, or share the form as needed.

Complete your CMS-701 form online today for efficient management of your outpatient rehabilitation claims.