BILLING FORM. (a) The RTC shall use the Centers for Medicare and Medicaid Services (CMS) 1450 UB-04 billing form (or most current subsequent editions). (b) RTCs shall identify RTC care on the billing form in the remarks block by stating “RTC care”. (c) RTCs shall identify on the billing form those days that patient was absent from the facility. This includes therapeutic absences as well as unplanned absences. (d) Charges for geographically distant family therapy must be billed in the RTC patient’s name and be authorized by DHA or designee.
Appears in 8 contracts
Samples: Participation Agreement, Participation Agreement, Participation Agreement
