As the health care industry’s most comprehensive library of customizable policy and procedure templates, MCN Healthcare’s Home Care Corporate Compliance Manual includes this customizable template, HCFA Billing Form. MCN’s policy library helps you meet compliance with Joint Commission and federal regulations including CMS, CDC, OSHA, OIG, HIPAA and more.

MCN’s templates save you time, money and resources, rather than developing healthcare policy and procedure manuals from scratch.

Here is some sample content from HCFA Billing Form:

	POLICY: The HCFA billing form shall be completed in accordance with the Medicare requirements as outlined in the Medicare Carriers Manual, Section 3043 in such a manner as to accurately portray the medical necessity of the items or services provided to Medicare patients. The form shall accurately reflect the location where the item or service was provided. PROCEDURE: When the patient has signed a written notice, the modifier GA shall be included on the claim. When the patient requests, in writing, that the organization submit the claim, the modifier 'ZY shall appear on the claim. All...
Second excerpt:
	... that the organization submit the claim, the modifier 'ZY shall appear on the claim. All items included on the Medicare claim form and that were provided to the patient shall be clearly differentiated as new or used: New items are to be designated with the modifier 'NU Used items are to be designated with the modifier UE SUBJECT: HCFA BILLING FORM REFERENCE #2003 PAGE: 1 DEPARTMENT: HOME CARE OF: 1 EFFECTIVE: APPROVED BY: REVISED: ...