Common use of BILLING FORM Clause in Contracts

BILLING FORM. (a) The hospice program shall use the Centers for Medicare and Medicaid Services (CMS) 1450 UB-04 billing form (or subsequent editions.) Hospice care shall be identified in item 4 of this form. (b) The CMS 1450 UB-04 billing form (or subsequent editions) will also be used as an admission notice. This notice will be used to notify the contractor of the initiation, change or revocation of an election.

BILLING FORM. (a) The hospice program shall use the Centers for Medicare and Medicaid Services (CMS) CMS 1450 UB-04 billing form (or subsequent editions.) Hospice care shall be identified in item 4 of this form. (b) The CMS 1450 UB-04 billing form (or subsequent editions) will also be used as an admission notice. This notice will be used to notify the contractor of the initiation, change or revocation of an election.