- Legal
- United States Legal Forms
- United States Federal Legal Forms
- U.S. Department of Health and Human Services
- U.S. Department of Health and Human Services - Centers for Medicare and Medicaid Services
Documents
Form CMS-40B "Application for Enrollment in Medicare Part B (Medical Insurance)"
This application is supposed to be used by individuals when they want to apply for enrollment in Medicare Part B, insurance which provides outpatient medical coverage.
Form CMS-671 "Long-Term Care Facility Application for Medicare and Medicaid"
This is a document developed for nursing facilities which are supposed to be filed during standard or extended health surveys.
Form CMS L564 "Request for Employment Information"
This is a legal document which must be completed to prove the group health plan coverage based on your or your spouse's current employment.
Form CMS-853 "Certificate of Medical Necessity"
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"
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"
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.
Sample "Medicaid Renewal Form"
File this renewal form annually in order to renew your Medicare coverage.
"Application for Health Coverage & Help Paying Costs"
This application is a legal document used to apply for and enroll in Marketplace health coverage with the DHHS.
Form CMS-846 "Certificate of Medical Necessity - Pneumatic Compression Devices"
