Medicare Documentation Flashcards

Flashcards for Medicare Documentation Lecture

700 Form

Medicare documentation form with numbered sections and step-by-step instructions.

Numbers 11, 21, and 22 on the 700 Form

Left blank until the end of the certification period.

Section 1

Patient's name

Section 2 (Provider Number)

Facility number issued by Medicare

Section 3

Patient's Social Security Number

Section 4

Provider name (e.g., LSC-T)

Section 5

Patient's record number

Section 6 (Onset Date)

Date the condition or injury occurred

Section 7 (Start of Care Date)

Date the form is completed; start of care date

Section 8

Check the box representing the therapy being provided.

Section 9 (Primary Diagnosis)

Medical diagnosis for the referral

Section 10 (Treatment Diagnosis)

Reason for treating the patient

Section 19

Prior hospitalization information, or NA if longer than two months ago.

Section 20

Describe the patient's medical history, complications, and level of function (what they CAN do).

When to Complete Section 20

Complete prior to writing goals, creating a plan, obtaining a signature, completing the frequency and duration, and documenting the certification period.

Section 12 - Long Term and Short Term Goals

Functional, objective, and measurable statements of what the patient will achieve.

Plan (next to Section 12)

Simplistic description of treatment plan, such as 'increase strength'.

Section 13

Signature of OTA/OT followed by credentials

Section 14

Frequency and duration of therapy services.

Sections 15 and 16

Physician's signature date.