Omb no 0938 0986-2026

See details

4 out of 5

59 votes

The document is a Rehabilitation Unit Criteria Worksheet from the Centers for Medicare & Medicaid Services (CMS) that outlines the requirements for a rehabilitation unit to be excluded from Medicare's acute care hospital prospective payment system. It details the necessary criteria, regulations, and verification processes that hospitals must meet to ensure compliance, including staffing, patient admission criteria, medical supervision, and documentation of treatment plans. The form must be completed by a hospital representative and verified by CMS surveyors.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out OMB No. 0938-0986 with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the OMB No. 0938-0986 in the editor.
Begin by entering the facility name and address in the designated fields. Ensure accuracy as this information is crucial for identification.
Fill in the related Medicare provider number, room numbers, and number of beds in the unit. This data helps establish compliance with Medicare regulations.
Indicate the survey date and specify the request for exclusion for the cost reporting period. Use the calendar tool for precise date selection.
For each criterion listed under Subpart B of Part 412, select 'YES', 'NO', or 'N/A' based on your hospital's compliance status. Be thorough and consult relevant departments if needed.
Finally, ensure that all sections are completed accurately before saving or submitting your form through our platform.

Start using our platform today to streamline your form completion process for free!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How can I send my omb no 0938 0986 from Google Drive for approval?

If you often work with documents stored in your Google Drive, DocHub is a superb solution for you to easily and quickly complete, edit, and sign them. This editor integrates properly with Google services, so you can export your omb no 0938 0986 from your Google Drive to the editor without the need of downloading and re-uploading it. Right-click on your file, select Open With → DocHub PDF Sign and Edit. In our editor, add and assign Signature Fields for all people involved, then click on the Menu option above → Send → choose how you want to share your paperwork.

How do you edit omb no 0938 0986 online?

With DocHub, you have several convenient methods to edit your omb no 0938 0986 online. You can drag and drop the form and modify it directly at the DocHub website or use our browser extension to fill out your form immediately. On top of that, you can modify your PDF on your phone, as DocHub works with all the available mobile platforms.