Patient Notification of Hospice Non-Covered Items, Services, & Drugs - DIGITAL FORM
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UPDATED 2024
The purpose of this addendum is to notify the requesting Medicare beneficiary (or representative), in writing, of those conditions, items, services, and drugs not covered by the hospice because the hospice has determined they are unrelated to the beneficiaries terminal illness and related conditions.
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*SUBSCRIPTION: Form access is licensed for 1-year per agency/facility location. Multiple sites require a quote. This digital form is delivered as a form-fillable PDF and includes 1-year of updates. To receive your electronic file and updates you must complete and return a content license agreement and provide an end-user email address and contact name for file delivery (please allow 2-3 business days for order fulfillment) and provide the facility/agency address. After 1- year, your subscription will automatically renew.
All Briggs Digital on Demand products require a credit card payment (or pre-payment) to receive digital files electronically.
Briggs Healthcare does not allow use of any of its intellectual property without a valid license and payment of fees.