Alabama - Get Certification as a supplier of portable X-Ray Service

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Procedure

Apply In-Person:

1. The applicant has to reach out to department of health and human services form approved centers for Medicare & Medicaid services state Agencyfor the [application.Contact Link] details are mentioned in “Office Locations & Contacts” of this page.Or Use the given following Contact Link
2. An application form is also available at the following Link
3. The applicant should make sure to carry all the documents that are mentioned under the “Required Documents” section of this page (Both photocopies and originals).
4. Applicant has to fill in all the necessary details in the form and attach the photocopies of the documents that are needed along with the application form before submitting.
5. There is no fee required for this procedure.
6. Submitting this form will begin the process of determining if the conditions of participation have been met.
7. Even if specific information is not currently accessible, do not procrastinate in returning the form.
8. The state agency can assist you in filling out the application.
9. Answer all questions as of the current date. Return the original and first two copies to the State agency in the envelope provided;retain the last copy for your files. If a return envelope is not provided, the name and address of the State agency may be obtainedfrom the nearest Social Security office.
10. The processing time may take 30 – 60 days.
11. Get in touch with the state agency that has a contract with the Centers for Medicare and Medicaid Services (CMS) for further information about the status of the application.

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Required Documents

• Application form
• Two copies of the form to the State agency
• All Medicare requirement document (if needed)

Office Locations & Contacts

Main office:
Address: Centers For Medicare & Medicaid Services (CMS)
7500 Security Boulevard, Baltimore, MD 21244
Medicare Service Center: 800-MEDICARE (800-633-4227)
Medicare Service Center TTY: 877-486-2048
Report Medicare Fraud & Abuse: 800-HHS-TIPS (1-800-447-8477)
Social Security: 800-772-1213
Contact Link

CMS Regional Office:
Contact Link
Contact Link

Local Office:
Contact Link

Note:
Provide Zip code to find Social Security Office to contact State agency.

Eligibility

• The applicant as graduated from a physical therapy curriculum.
• The medical services of the clinic are provided by a group of physicians.
• Physician is present in the clinic at all times to perform medical (rather than administrative) services.
• The applicant has 2 years of appropriate experience as a physical therapist and has achieved a satisfactory gradeon a proficiency examination approved by the Secretary, except that such determinations of proficiency shall not apply with respectto persons initially licensed by a State or seeking qualification as a physical therapist.
• The applicant has 15 years of full-time experience in the treatmentof illness or injury through the practice of physical therapy.
• For more details see instructions in the application.

Fees

• There is no fee required for this procedure.

Validity

• CMS will display in the Office of Management and Budget (OMB) about the expiration date.

Documents to Use

• An application form is available at the following Link

Sample Documents

Please attach sample completed documents that would help other people.

Processing Time

• The processing time may take 30 – 60 days.

Related Videos

Videos explaining the procedure or to fill the applications.
Attach videos using the following tag <&video type='website'>video ID|width|height<&/video&>
from external websites.
Please remove the '&' inside the emptags during implementation.
Website = allocine, blip, dailymotion, facebook, gametrailers, googlevideo, html5, metacafe, myspace, revver,
sevenload, viddler, vimeo, youku, youtube
width = 560, height = 340, Video ID = Can be obtained from the URL of webpage where the video is displayed.
e.gIn the following url 'http://www.youtube.com/watch?v=Y0US7oR_t3M' Video ID is 'Y0US7oR_t3M'.

Instructions

• The application and survey forms do not duplicate any information collection. The forms address specific requirements for certification as a portable X-ray supplier. State survey agencies conduct these reviews with Federal funds under contract with CMS.

Required Information

The information needed to be filled in the application form are listed below:

• Request To Establish Eligibility In
• Medicare/Medicaid Provider Number
• State/County
• State Region
• Identifying Information
• Qualification of Director
• Type of Ownership or Control
• Number of Technologists

Need for the Document

• The form CMS-1880, Request for Certification as a Supplier of Portable X-Ray Services under the Medicare program, is initially completed by the suppliers of portable X-ray services, expressing an interest in and requesting participation in the Medicare program.
• This form initiates the process of obtaining a decision as to whether the conditions of coverage are met as a portable X-ray supplier.
• It also promotes data reduction or introduction to, and retrieval from, the Certification and Survey Provider Enhanced Reporting (CASPER) by the CMS Regional Offices (ROs).

Information which might help

• For more information click “Download” and go through the Supporting statement Link

Other uses of the Document/Certificate

• The information from this form will be used by CMS in making certification decisions. The information on the form serves as a screen for the State survey agency to determine if the portable X-ray supplier has the basic capabilities to participate in the Medicare program, and whether a survey is appropriate.
• The basic identifying information from this form is coded into ASPEN and serves as the information based for the creation of a record for future Federal certification and for monitoring activity.

External Links

Place some external links which might help.

Others

More information which might help people.