U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services Forms

64
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64

Form CMS-853 "Certificate of Medical Necessity"

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4.3(4.3 / 5) 58 votes
Size: 63 KB
2 pages

File this form to document that the use of the medical equipment used for enteral nutrition is justified. This part of the procedure is called the medical necessity, which is a way to have Medicare compensate the costs of items and services that are considered necessary.

Form CMS-485 "Home Health Certification and Plan of Care"

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4.4(4.4 / 5) 42 votes
Size: 31 KB
2 pages

This form is filled out by the patient's attending physician and used as a fiduciary document in order to authorize professional health services.

Form CMS-1763 "Request for Termination of Premium Hospital and/or Supplementary Medical Insurance"

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4.6(4.6 / 5) 98 votes
Size: 65 KB
1 page

This is a legal document that any Medicare enrollee may use to terminate hospital insurance and supplementary medical insurance. This form was released by the U.S. Department of Health and Human Services.