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Case 1311634KJC Doc 86 Filed 08/02/13-Page 1 of 2 IN THE UNITED STATES BANKRUPTCY COURT FOR THE DISTRICT OF DELAWARE x : : Chapter 11 In re: : : Case No. 1311634 (JC) Mercantile Ban corp, Inc., :
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To fill out the MBI - CoC Re (Medicaid Brief Inpatient - Conditions of Coverage Review), follow these steps:
01
Gather necessary information: Obtain the patient's medical records, admission and discharge dates, and relevant documentation regarding the treatment provided during the inpatient stay.
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Begin the form: Start by filling out the patient's demographic information, including their name, date of birth, Social Security number, and Medicaid identification number.
03
Provide facility details: Identify the name and address of the hospital or healthcare facility where the inpatient stay occurred.
04
Enter admission and discharge details: Indicate the date and time of the patient's admission to the facility and their discharge date and time.
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Describe the primary diagnosis: Specify the primary reason for the patient's hospitalization. This should be the condition that required the most significant treatment or intervention.
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List any secondary diagnoses: If applicable, include any additional diagnoses that were relevant to the patient's treatment during their inpatient stay.
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Document procedures and treatments: Detail the medical procedures, surgeries, medications, and therapies provided to the patient during their hospitalization. Be sure to include the date and description of each intervention.
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Provide attending and consulting physician information: Include the names, credentials, and contact information of the attending physician and any other consultants involved in the patient's care.
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Explain any complications or adverse events: If the patient experienced any complications or adverse events during their hospitalization, describe them clearly.
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Sign and date the form: Once you have completed all the required sections, sign and date the MBI - CoC Re form.

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01
Healthcare providers: Medical professionals involved in the care and treatment of Medicaid patients who have undergone an inpatient stay may need to fill out the MBI - CoC Re form. This includes physicians, surgeons, nurses, and other healthcare personnel responsible for documenting the patient's medical history and treatment plan.
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Medicaid organizations: Medicaid organizations or managed care companies may require the submission of the MBI - CoC Re form to review the appropriateness of the inpatient treatment provided and ensure compliance with Medicaid guidelines.
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Billing departments: Hospital billing departments or administrative staff may need to complete the MBI - CoC Re form to provide accurate information for reimbursement purposes and to comply with Medicaid regulations.
Overall, anyone involved in the inpatient care and reimbursement process for Medicaid patients may need to fill out the MBI - CoC Re form. It helps ensure appropriate documentation, compliance, and accurate reimbursement for the provided medical services.
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MBI-COCRE stands for Manufacturers' and Business Inventories - Census of Commerce and Revenues. It is a report that gathers information on manufacturers and businesses' inventories, commerce, and revenues.
All manufacturers and businesses are required to file MBI-COCRE.
MBI-COCRE can usually be filled out online through the designated platform provided by the Census Bureau.
The purpose of MBI-COCRE is to gather data on inventories, commerce, and revenues of manufacturers and businesses for statistical analysis and economic planning.
Information such as inventory levels, sales revenue, business type, and other relevant financial data must be reported on MBI-COCRE.
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