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pdfPBP 2013 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute – Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 1 of 200
PBP 2013 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute – Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 2 of 200
PBP 2013 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute – Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 3 of 200
PBP 2013 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute – Base 4 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 4 of 200
PBP 2013 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute – Base 5 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 5 of 200
PBP 2013 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute – Base 6 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 6 of 200
PBP 2013 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute – Base 7 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 7 of 200
PBP 2013 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute – Base 8 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 8 of 200
PBP 2013 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute – Base 9 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 9 of 200
PBP 2013 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute – Base 10 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 10 of 200
PBP 2013 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute – Base 11 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 11 of 200
PBP 2013 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute – Base 12 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 12 of 200
PBP 2013 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute (B Only) – Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 13 of 200
PBP 2013 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute (B Only) – Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 14 of 200
PBP 2013 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute (B Only) – Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 15 of 200
PBP 2013 Data Entry System Screens
Section B - 1A - Inpatient Hospital-Acute (B Only) – Base 4 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 16 of 200
PBP 2013 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric – Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 17 of 200
PBP 2013 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric – Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 18 of 200
PBP 2013 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric – Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 19 of 200
PBP 2013 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric – Base 4 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 20 of 200
PBP 2013 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric – Base 5 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 21 of 200
PBP 2013 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric – Base 6 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 22 of 200
PBP 2013 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric – Base 7 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 23 of 200
PBP 2013 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric – Base 8 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 24 of 200
PBP 2013 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric – Base 9 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 25 of 200
PBP 2013 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric – Base 10 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 26 of 200
PBP 2013 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric – Base 11 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 27 of 200
PBP 2013 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric – Base 12 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 28 of 200
PBP 2013 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric (B Only) – Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 29 of 200
PBP 2013 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric (B Only) – Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 30 of 200
PBP 2013 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric (B Only) – Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 31 of 200
PBP 2013 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric (B Only) – Base 4 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 32 of 200
PBP 2013 Data Entry System Screens
Section B – 1B - Inpatient Hospital Psychiatric (B Only) – Base 5 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 33 of 200
PBP 2013 Data Entry System Screens
Section B – 2 – Skilled Nursing Facility – Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 34 of 200
PBP 2013 Data Entry System Screens
Section B – 2 – Skilled Nursing Facility – Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 35 of 200
PBP 2013 Data Entry System Screens
Section B – 2 – Skilled Nursing Facility – Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 36 of 200
PBP 2013 Data Entry System Screens
Section B – 2 – Skilled Nursing Facility – Base 4 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 37 of 200
PBP 2013 Data Entry System Screens
Section B – 2 – Skilled Nursing Facility – Base 5 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 38 of 200
PBP 2013 Data Entry System Screens
Section B – 2 – Skilled Nursing Facility – Base 6 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 39 of 200
PBP 2013 Data Entry System Screens
Section B – 2 – Skilled Nursing Facility – Base 7 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 40 of 200
PBP 2013 Data Entry System Screens
Section B – 2 – Skilled Nursing Facility (B Only) – Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 41 of 200
PBP 2013 Data Entry System Screens
Section B – 2 – Skilled Nursing Facility (B Only) – Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 42 of 200
PBP 2013 Data Entry System Screens
Section B – 2 – Skilled Nursing Facility (B Only) – Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 43 of 200
PBP 2013 Data Entry System Screens
Section B – 2 – Skilled Nursing Facility (B Only) – Base 4 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 44 of 200
PBP 2013 Data Entry System Screens
Section B – 3 – Cardiac and Pulmonary Rehabilitation Services – Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 45 of 200
PBP 2013 Data Entry System Screens
Section B – 3 – Cardiac and Pulmonary Rehabilitation Services – Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 46 of 200
PBP 2013 Data Entry System Screens
Section B – 3 – Cardiac and Pulmonary Rehabilitation Services – Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 47 of 200
PBP 2013 Data Entry System Screens
Section B – 3 – Cardiac and Pulmonary Rehabilitation Services – Base 4 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 48 of 200
PBP 2013 Data Entry System Screens
Section B – 4A – Emergency Care – Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 49 of 200
PBP 2013 Data Entry System Screens
Section B – 4A – Emergency Care – Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 50 of 200
PBP 2013 Data Entry System Screens
Section B – 4A – Emergency Care – Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 51 of 200
PBP 2013 Data Entry System Screens
Section B – 4A – Emergency Care – Base 4 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 52 of 200
PBP 2013 Data Entry System Screens
Section B – 4B – Urgently Needed Care – Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 53 of 200
PBP 2013 Data Entry System Screens
Section B – 4B – Urgently Needed Care – Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 54 of 200
PBP 2013 Data Entry System Screens
Section B – 4B – Urgently Needed Care – Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 55 of 200
PBP 2013 Data Entry System Screens
Section B – 5 – Partial Hospitalization – Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 56 of 200
PBP 2013 Data Entry System Screens
Section B – 5 – Partial Hospitalization – Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 57 of 200
PBP 2013 Data Entry System Screens
Section B – 6 – Home Health Services – Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 58 of 200
PBP 2013 Data Entry System Screens
Section B – 6 – Home Health Services – Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 59 of 200
PBP 2013 Data Entry System Screens
Section B – 6 – Home Health Services – Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 60 of 200
PBP 2013 Data Entry System Screens
Section B – 7A – Primary Care Physician Services – Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 61 of 200
PBP 2013 Data Entry System Screens
Section B – 7A – Primary Care Physician Services – Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 62 of 200
PBP 2013 Data Entry System Screens
Section B – 7B – Chiropractic Services – Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 63 of 200
PBP 2013 Data Entry System Screens
Section B – 7B – Chiropractic Services – Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 64 of 200
PBP 2013 Data Entry System Screens
Section B – 7B – Chiropractic Services – Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 65 of 200
PBP 2013 Data Entry System Screens
Section B – 7B – Chiropractic Services – Base 4 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 66 of 200
PBP 2013 Data Entry System Screens
Section B – 7C – Occupational Therapy Services – Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 67 of 200
PBP 2013 Data Entry System Screens
Section B – 7C – Occupational Therapy Services – Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 68 of 200
PBP 2013 Data Entry System Screens
Section B – 7D – Physician Specialist Services – Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 69 of 200
PBP 2013 Data Entry System Screens
Section B – 7D – Physician Specialist Services – Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 70 of 200
PBP 2013 Data Entry System Screens
Section B – 7E – Mental Health Specialty Services – Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 71 of 200
PBP 2013 Data Entry System Screens
Section B – 7E – Mental Health Specialty Services – Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 72 of 200
PBP 2013 Data Entry System Screens
Section B – 7E – Mental Health Specialty Services – Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 73 of 200
PBP 2013 Data Entry System Screens
Section B – 7F – Podiatry Services – Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 74 of 200
PBP 2013 Data Entry System Screens
Section B – 7F – Podiatry Services – Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 75 of 200
PBP 2013 Data Entry System Screens
Section B – 7F – Podiatry Services – Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 76 of 200
PBP 2013 Data Entry System Screens
Section B – 7G – Other Health Care Professional – Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 77 of 200
PBP 2013 Data Entry System Screens
Section B – 7G – Other Health Care Professional – Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 78 of 200
PBP 2013 Data Entry System Screens
Section B – 7H – Psychiatric Services – Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 79 of 200
PBP 2013 Data Entry System Screens
Section B – 7H – Psychiatric Services – Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 80 of 200
PBP 2013 Data Entry System Screens
Section B – 7H – Psychiatric Services – Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 81 of 200
PBP 2013 Data Entry System Screens
Section B – 7I – Physical Therapy and Speech-Language Pathology Services– Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 82 of 200
PBP 2013 Data Entry System Screens
Section B – 7I – Physical Therapy and Speech-Language Pathology Services– Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 83 of 200
PBP 2013 Data Entry System Screens
Section B – 8A– Outpatient Diagnostic Procedures, Tests, and Diagnostic Lab Services– Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 84 of 200
PBP 2013 Data Entry System Screens
Section B – 8A– Outpatient Diagnostic Procedures, Tests, and Diagnostic Lab Services– Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 85 of 200
PBP 2013 Data Entry System Screens
Section B – 8A– Outpatient Diagnostic Procedures, Tests, and Diagnostic Lab Services– Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 86 of 200
PBP 2013 Data Entry System Screens
Section B – 8A– Outpatient Diagnostic Procedures, Tests, and Diagnostic Lab Services– Base 4 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 87 of 200
PBP 2013 Data Entry System Screens
Section B – 8B– Outpatient Diagnostic and Therapeutic Radiological Services – Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 88 of 200
PBP 2013 Data Entry System Screens
Section B – 8B– Outpatient Diagnostic and Therapeutic Radiological Services – Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 89 of 200
PBP 2013 Data Entry System Screens
Section B – 8B– Outpatient Diagnostic and Therapeutic Radiological Services – Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 90 of 200
PBP 2013 Data Entry System Screens
Section B – 9A– Outpatient Hospital Services – Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 91 of 200
PBP 2013 Data Entry System Screens
Section B – 9A– Outpatient Hospital Services – Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 92 of 200
PBP 2013 Data Entry System Screens
Section B – 9A– Outpatient Hospital Services – Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 93 of 200
PBP 2013 Data Entry System Screens
Section B – 9B– Ambulatory Surgical Center Services– Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 94 of 200
PBP 2013 Data Entry System Screens
Section B – 9B– Ambulatory Surgical Center Services– Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 95 of 200
PBP 2013 Data Entry System Screens
Section B – 9B– Ambulatory Surgical Center Services– Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 96 of 200
PBP 2013 Data Entry System Screens
Section B – 9C– Outpatient Substance Abuse– Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 97 of 200
PBP 2013 Data Entry System Screens
Section B – 9C– Outpatient Substance Abuse– Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 98 of 200
PBP 2013 Data Entry System Screens
Section B – 9C– Outpatient Substance Abuse– Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 99 of 200
PBP 2013 Data Entry System Screens
Section B – 9D– Outpatient Blood Services– Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 100 of 200
PBP 2013 Data Entry System Screens
Section B – 9D– Outpatient Blood Services– Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 101 of 200
PBP 2013 Data Entry System Screens
Section B – 10A– Ambulance Services– Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 102 of 200
PBP 2013 Data Entry System Screens
Section B – 10A– Ambulance Services– Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 103 of 200
PBP 2013 Data Entry System Screens
Section B – 10B–Transportation Services– Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 104 of 200
PBP 2013 Data Entry System Screens
Section B – 10B–Transportation Services– Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 105 of 200
PBP 2013 Data Entry System Screens
Section B – 10B–Transportation Services– Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 106 of 200
PBP 2013 Data Entry System Screens
Section B – 11A–Durable Medical Equipment– Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 107 of 200
PBP 2013 Data Entry System Screens
Section B – 11A–Durable Medical Equipment– Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 108 of 200
PBP 2013 Data Entry System Screens
Section B – 11B–Prosthetics and Medical Supplies– Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 109 of 200
PBP 2013 Data Entry System Screens
Section B – 11B–Prosthetics and Medical Supplies– Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 11B–Prosthetics and Medical Supplies– Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
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Section B – 11C–Diabetic Supplies and Services– Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 11C–Diabetic Supplies and Services– Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 12–End-Stage Renal Disease– Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 12–End-Stage Renal Disease– Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 13A–Acupuncture– Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 13A–Acupuncture– Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 13A–Acupuncture– Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 13B–Over the Counter Drugs– Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 13B–Over the Counter Drugs– Base 2 Screen
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12/9/2011
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Section B – 13B–Over the Counter Drugs– Base 3 Screen
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Section B – 13C–Meal Benefit– Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 13C–Meal Benefit– Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 13C–Meal Benefit– Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 13D–Other 1– Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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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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CY 2013 PBP – Section B
12/9/2011
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Section B – 13E–Other 2– Base 1 Screen
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CY 2013 PBP – Section B
12/9/2011
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Section B – 13E–Other 2– Base 2 Screen
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CY 2013 PBP – Section B
12/9/2011
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Section B – 13E–Other 2– Base 3 Screen
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CY 2013 PBP – Section B
12/9/2011
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Section B – 13F–Other 3– Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 13F–Other 3– Base 2 Screen
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CY 2013 PBP – Section B
12/9/2011
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Section B – 13F–Other 3– Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 13G–High Quality Special Needs Plan– Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 13G–High Quality Special Needs Plan– Base 2 Screen
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CY 2013 PBP – Section B
12/9/2011
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Section B – 13G–High Quality Special Needs Plan– Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 14A–Medicare-covered Preventive Services– Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 14B–Annual Physical Exam– Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 14B–Annual Physical Exam– Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 14B–Annual Physical Exam– Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 14C–Supplemental Education and Wellness Programs– Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 14C–Supplemental Education and Wellness Programs– Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 14C–Supplemental Education and Wellness Programs– Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 14C–Supplemental Education and Wellness Programs– Base 4 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 14C–Supplemental Education and Wellness Programs– Base 5 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 14D–Kidney Disease Education Services– Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 14D–Kidney Disease Education Services– Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 14D–Kidney Disease Education Services– Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 14E–Diabetes Self-Management Training– Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 14E–Diabetes Self-Management Training– Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 14E–Diabetes Self-Management Training– Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 15–Medicare Part B Rx Drugs– Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 15–Medicare Part B Rx Drugs– Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 15–Medicare Part B Rx Drugs– Notes (Optional) Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 15–Home Infusion Bundled Services– Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 16A–Preventive Dental–Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 16A–Preventive Dental–Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 16A–Preventive Dental–Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 16A–Preventive Dental–Base 4 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 16A–Preventive Dental–Base 5 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 16B–Comprehensive Dental–Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 16B–Comprehensive Dental–Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 16B–Comprehensive Dental–Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 16B–Comprehensive Dental–Base 4 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 16B–Comprehensive Dental–Base 5 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 16B–Comprehensive Dental–Base 6 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 17A–Eye Exams–Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 17A–Eye Exams–Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 17A–Eye Exams–Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 17B–Eye Wear–Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 17B–Eye Wear–Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 17B–Eye Wear–Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 17B–Eye Wear–Base 4 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 17B–Eye Wear–Base 5 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 17B–Eye Wear–Base 6 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 18A–Hearing Exams–Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 18A–Hearing Exams–Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 18A–Hearing Exams–Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 18A–Hearing Exams–Base 4 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 18B–Hearing Aids–Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 18B–Hearing Aids–Base 2 Screen
Fu Associates, Ltd.
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12/9/2011
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Section B – 18B–Hearing Aids–Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 18B–Hearing Aids–Base 4 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 18B–Hearing Aids–Base 5 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 20–Outpatient Drugs–Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 20–Outpatient Drugs–Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 20–Outpatient Drugs–Base 3 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 20–Outpatient Drugs–Base 4 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 20–Outpatient Drugs–Notes (Optional) Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 20–Outpatient Drugs-Group 1–Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 20–Outpatient Drugs-Group 1–Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 20–Outpatient Drugs-Group 2–Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 20–Outpatient Drugs-Group 2–Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 20–Outpatient Drugs-Group 3–Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 20–Outpatient Drugs-Group 3–Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 20–Outpatient Drugs-Group 4–Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 20–Outpatient Drugs-Group 4–Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 20–Outpatient Drugs-Group 5–Base 1 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
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Section B – 20–Outpatient Drugs-Group 5–Base 2 Screen
Fu Associates, Ltd.
CY 2013 PBP – Section B
12/9/2011
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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Section B – 20–Home Infusion Bundled Services– Screen
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| File Type | application/pdf |
| File Title | Section B - 1A - Inpatient Hospital-Acute – Base 1 Screen |
| Author | meyer |
| File Modified | 2011-12-09 |
| File Created | 2011-12-09 |