CMS-724 1994-2025 free printable template

DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES FORM APPROVED OMB NO. 0938-0378 MEDICARE/MEDICAID PSYCHIATRIC HOSPITAL SURVEY DATA SECTION I: to be completed by hospital

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How to fill out CMS-724

1. Obtain the CMS-724 form from the official CMS website or your healthcare provider.
2. Fill out the patient information section, including name, date of birth, and address.
3. Provide the referring physician's details if applicable.
4. Document the health condition or service reason for the CMS-724 form.
5. Indicate the specific services being requested.
6. Review the form for accuracy and completeness.
7. Submit the completed CMS-724 form to the appropriate Medicare administrative contractor or the specified address.

Who needs CMS-724?

1. Individuals enrolling in Medicare services for the first time.
2. Healthcare providers seeking authorization for specific medical services.
3. Patients requiring coverage for durable medical equipment or therapy services.

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What is CMS-724?

CMS-724 is a form used by providers to report certain information related to the use of Medicare services under the Centers for Medicare & Medicaid Services.

Who is required to file CMS-724?

Providers of Medicare services are required to file CMS-724 if they are involved in certain patient care activities or events that must be reported to CMS.

How to fill out CMS-724?

To fill out CMS-724, providers should gather the necessary patient and service information, complete the required sections on the form accurately, and submit it according to the guidelines provided by CMS.

What is the purpose of CMS-724?

The purpose of CMS-724 is to ensure accurate reporting of specific healthcare activities and to maintain compliance with Medicare regulations.

What information must be reported on CMS-724?

The information that must be reported on CMS-724 includes patient demographics, types of services provided, any incidents or events related to patient care, and other pertinent details as specified by CMS.