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MARYLAND MEDICAL ASSISTANCE PROGRAMUB04 BILLING INSTRUCTIONS FOR FREESTANDING DIALYSIS FACILITY SERVICES Updated August 14, 2017, Rev. 08/14/17Page 1 of 19UB04 Instructions TABLE of CONTENTS Introduction

How to fill out standing dialysis facility services

How to fill out standing dialysis facility services

1. Gather all the necessary paperwork and forms needed to fill out.
2. Make sure you have all the information regarding the patient's medical history and current condition.
3. Carefully read and understand the instructions provided for filling out the standing dialysis facility services form.
4. Enter the patient's personal information accurately and completely, including their full name, address, contact number, and insurance details.
5. Provide detailed information about the patient's primary care physician, nephrologist, and any other healthcare professionals involved in their treatment.
6. Indicate the preferred dialysis facility and specific services required for the patient.
7. Include any additional information or special instructions that may be necessary for the facility to know.
8. Review the completed form for any errors or missing information.
9. Submit the filled-out form to the appropriate authority or department responsible for processing standing dialysis facility services.

Who needs standing dialysis facility services?

1. Individuals suffering from chronic kidney disease (CKD) or end-stage renal disease (ESRD) who require regular dialysis treatment.
2. Patients who have difficulty traveling to a dialysis center and would benefit from receiving dialysis services at a standing facility closer to their residence.
3. Individuals who have limited mobility or are unable to leave their home for dialysis treatment.
4. Patients who prefer the convenience and comfort of receiving dialysis services in a standing facility rather than a traditional dialysis center.

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What is standing dialysis facility services?

Standing dialysis facility services refer to the continuous provision of dialysis treatment in a healthcare facility.

Who is required to file standing dialysis facility services?

Healthcare facilities offering dialysis services are required to file standing dialysis facility services.

How to fill out standing dialysis facility services?

Standing dialysis facility services should be filled out following the guidelines provided by the relevant health authorities.

What is the purpose of standing dialysis facility services?

The purpose of standing dialysis facility services is to ensure continuous and quality care for patients requiring dialysis treatment.

What information must be reported on standing dialysis facility services?

Information such as patient demographics, treatment schedules, medical history, and outcomes must be reported on standing dialysis facility services.