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pdfPBP 2012 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 1 of 199
PBP 2012 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute – Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 3 of 199
PBP 2012 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute – Base 4 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute – Base 5 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute – Base 6 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute – Base 7 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute – Base 8 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute – Base 9 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute – Base 10 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute (B Only) – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute (B Only) – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute (B Only) – Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute (B Only) – Base 4 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric – Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric – Base 4 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric – Base 5 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric – Base 6 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric – Base 7 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric – Base 8 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric – Base 9 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric – Base 10 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric (B Only) – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric (B Only) – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric (B Only) – Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric (B Only) – Base 4 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 1B - Inpatient Hospital Psychiatric (B Only) – Base 5 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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PBP 2012 Data Entry System Screens
Section B – 2 - SNF – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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PBP 2012 Data Entry System Screens
Section B – 2 - SNF – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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PBP 2012 Data Entry System Screens
Section B – 2 - SNF – Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 2 - SNF – Base 4 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 2 - SNF – Base 5 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 2 - SNF – Base 6 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 2 - SNF – Base 7 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 2 – SNF (B Only) – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 2 – SNF (B Only) – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 2 – SNF (B Only) – Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 2 – SNF (B Only) – Base 4 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 3 – Cardiac and Pulmonary Rehabilitation Services – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 3 – Cardiac and Pulmonary Rehabilitation Services – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 3 – Cardiac and Pulmonary Rehabilitation Services – Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 3 – Cardiac and Pulmonary Rehabilitation Services – Base 4 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 4A – Emergency Care – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 4A – Emergency Care – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
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Section B – 4A – Emergency Care – Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
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Section B – 4A – Emergency Care – Base 4 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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PBP 2012 Data Entry System Screens
Section B – 4B – Urgently Needed Care – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 4B – Urgently Needed Care – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 4B – Urgently Needed Care – Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 5 – Partial Hospitalization – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 5 – Partial Hospitalization – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 6 – Home Health Services – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 6 – Home Health Services – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 6 – Home Health Services – Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 7A – Primary Care Physician Services – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 7A – Primary Care Physician Services – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 7A – Primary Care Physician Services – Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 7B – Chiropractic Services – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 7B – Chiropractic Services – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 7B – Chiropractic Services – Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 7B – Chiropractic Services – Base 4 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 7C – Occupational Therapy Services – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 7C – Occupational Therapy Services – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 7D – Physician Specialist Services – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 7D – Physician Specialist Services – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 7E – Mental Health Specialty Services – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 7E – Mental Health Specialty Services – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 7E – Mental Health Specialty Services – Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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PBP 2012 Data Entry System Screens
Section B – 7F – Podiatry Services – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 7F – Podiatry Services – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 7F – Podiatry Services – Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 7G – Other Health Care Professional – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 7G – Other Health Care Professional – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 7H – Psychiatric Services – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 7H – Psychiatric Services – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 7H – Psychiatric Services – Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 7I – PT and SP Services – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 7I – PT and SP Services – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 8A– Outpatient Diag Procs/Tests/Lab Services – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 8A– Outpatient Diag Procs/Tests/Lab Services – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 8A– Outpatient Diag Procs/Tests/Lab Services – Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 8A– Outpatient Diag Procs/Tests/Lab Services – Base 4 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 8B– Outpatient Diag/Therapeutic Rad Services – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 8B– Outpatient Diag/Therapeutic Rad Services – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 8B– Outpatient Diag/Therapeutic Rad Services – Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 9A– Outpatient Hospital Services – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 9A– Outpatient Hospital Services – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 9A– Outpatient Hospital Services – Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 9B– ASC Services – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 9B– ASC Services – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 9B– ASC Services – Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 9C– Outpatient Substance Abuse – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 9C– Outpatient Substance Abuse – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 9C– Outpatient Substance Abuse – Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 97 of 199
PBP 2012 Data Entry System Screens
Section B – 9D– Outpatient Blood Services – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 9D– Outpatient Blood Services – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 10A– Ambulance Services – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 10A– Ambulance Services – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 101 of 199
PBP 2012 Data Entry System Screens
Section B – 10B– Transportation Services – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 10B– Transportation Services – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 10B– Transportation Services – Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 11A– DME – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 11A– DME – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 11B– Prosthetics/Medical Supplies – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 107 of 199
PBP 2012 Data Entry System Screens
Section B – 11B– Prosthetics/Medical Supplies – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2012 Data Entry System Screens
Section B – 11B– Prosthetics/Medical Supplies – Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 109 of 199
PBP 2012 Data Entry System Screens
Section B – 11C– Diabetic Supplies and Services – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 110 of 199
PBP 2012 Data Entry System Screens
Section B – 11C– Diabetic Supplies and Services – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 12– End Stage Renal Disease – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 12– End Stage Renal Disease – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 13A– Acupuncture – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 13A– Acupuncture – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
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Section B – 13A– Acupuncture – Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
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Section B – 13B– OTC – Base 1 Screen
Fu Associates, Ltd.
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Section B – 13B– OTC – Base 2 Screen
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Section B – 13B– OTC – Base 3 Screen
Fu Associates, Ltd.
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Section B – 13C– Meal Benefit – Base 1 Screen
Fu Associates, Ltd.
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12/6/2010
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Section B – 13C– Meal Benefit – Base 2 Screen
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12/6/2010
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Section B – 13D– Other 1 – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 13D– Other 1 – Base 2 Screen
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Section B – 13D– Other 1 – Base 3 Screen
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Section B – 13E– Other 2 – Base 1 Screen
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12/6/2010
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Section B – 13E– Other 2 – Base 2 Screen
Fu Associates, Ltd.
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12/6/2010
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Section B – 13E– Other 2 – Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 14A– Medicare-covered Zero Cost Sharing Preventative Services – Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 14B– Supplemental Preventative Health Services – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 14B– Supplemental Preventative Health Services – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 14B– Supplemental Preventative Health Services – Base 3 Screen
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12/6/2010
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Section B – 14B– Supplemental Preventative Health Services – Base 4 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 14B– Supplemental Preventative Health Services – Base 5 Screen
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12/6/2010
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Section B – 14B– Supplemental Preventative Health Services – Base 6 Screen
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Section B – 14B– Supplemental Preventative Health Services – Base 7 Screen
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12/6/2010
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Section B – 14B– Supplemental Preventative Health Services – Base 8 Screen
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12/6/2010
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Section B – 14B– Supplemental Preventative Health Services – Base 9 Screen
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12/6/2010
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Section B – 14B– Supplemental Preventative Health Services – Base 10 Screen
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12/6/2010
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Section B – 14C– Supplemental Education/Wellness Programs – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 14C– Supplemental Education/Wellness Programs – Base 2 Screen
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Section B – 14C– Supplemental Education/Wellness Programs – Base 5 Screen
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12/6/2010
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Section B – 14D– Kidney Disease Education Services – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 14D– Kidney Disease Education Services – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 14D– Kidney Disease Education Services – Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 14E– Diabetes Self-Management Training – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 14E– Diabetes Self-Management Training – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
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Section B – 14E– Diabetes Self-Management Training – Base 3 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 15– Medicare Part B Rx Drugs – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 15– Medicare Part B Rx Drugs – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 15– Medicare Part B Rx Drugs – Notes (Optional) Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 15– Part C Home Infusion Bundled Services – Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 16A– Preventative Dental – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 16A– Preventative Dental – Base 2 Screen
Fu Associates, Ltd.
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Section B – 16A– Preventative Dental – Base 3 Screen
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Section B – 16B– Comprehensive Dental – Base 1 Screen
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Section B – 16B– Comprehensive Dental – Base 2 Screen
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Section B – 17A– Eye Exams – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 17A– Eye Exams – Base 2 Screen
Fu Associates, Ltd.
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Section B – 17A– Eye Exams – Base 3 Screen
Fu Associates, Ltd.
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12/6/2010
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Section B – 17B– Eye Wear – Base 1 Screen
Fu Associates, Ltd.
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Section B – 17B– Eye Wear – Base 3 Screen
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Section B – 17B– Eye Wear – Base 5 Screen
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Fu Associates, Ltd.
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Section B – 18A– Hearing Exams – Base 1 Screen
Fu Associates, Ltd.
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Section B – 18B– Hearing Aids – Base 1 Screen
Fu Associates, Ltd.
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Section B – 18B– Hearing Aids – Base 5 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 20– Outpatient Drugs – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 20– Outpatient Drugs – Notes (Optional) Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 20– Outpatient Drugs- Group 1 – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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12/6/2010
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Fu Associates, Ltd.
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12/6/2010
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Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 20– Outpatient Drugs- Group 3 – Base 2 Screen
Fu Associates, Ltd.
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12/6/2010
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Section B – 20– Outpatient Drugs- Group 4 – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 20– Outpatient Drugs- Group 4 – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 20– Outpatient Drugs- Group 5 – Base 1 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 20– Outpatient Drugs- Group 5 – Base 2 Screen
Fu Associates, Ltd.
CY 2012 PBP – Section B
12/6/2010
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Section B – 20– Part C Home Infusion Bundled Services – Screen
Fu Associates, Ltd.
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| File Type | application/pdf |
| Author | meyer |
| File Modified | 2010-12-06 |
| File Created | 2010-12-06 |