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pdfPBP 2015 Data Entry System Screens
#1a Inpatient Hospital – Acute – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 1 of 239
PBP 2015 Data Entry System Screens
#1a Inpatient Hospital – Acute – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 2 of 239
PBP 2015 Data Entry System Screens
#1a Inpatient Hospital – Acute – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 3 of 239
PBP 2015 Data Entry System Screens
#1a Inpatient Hospital – Acute – Base 4
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 4 of 239
PBP 2015 Data Entry System Screens
#1a Inpatient Hospital – Acute – Base 5
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 5 of 239
PBP 2015 Data Entry System Screens
#1a Inpatient Hospital – Acute – Base 6
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 6 of 239
PBP 2015 Data Entry System Screens
#1a Inpatient Hospital – Acute – Base 7
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 7 of 239
PBP 2015 Data Entry System Screens
#1a Inpatient Hospital – Acute – Base 8
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 8 of 239
PBP 2015 Data Entry System Screens
#1a Inpatient Hospital – Acute – Base 9
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 9 of 239
PBP 2015 Data Entry System Screens
#1a Inpatient Hospital – Acute – Base 10
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 10 of 239
PBP 2015 Data Entry System Screens
#1a Inpatient Hospital – Acute – Base 11
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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PBP 2015 Data Entry System Screens
#1a Inpatient Hospital – Acute – Base 12
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 12 of 239
PBP 2015 Data Entry System Screens
#1a Inpatient Hospital – Acute (B Only) – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 13 of 239
PBP 2015 Data Entry System Screens
#1a Inpatient Hospital – Acute (B Only) – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 14 of 239
PBP 2015 Data Entry System Screens
#1a Inpatient Hospital – Acute (B Only) – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 15 of 239
PBP 2015 Data Entry System Screens
#1a Inpatient Hospital – Acute (B Only) – Base 4
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 16 of 239
PBP 2015 Data Entry System Screens
#1b Inpatient Hospital Psychiatric – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 17 of 239
PBP 2015 Data Entry System Screens
#1b Inpatient Hospital Psychiatric – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 18 of 239
PBP 2015 Data Entry System Screens
#1b Inpatient Hospital Psychiatric – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 19 of 239
PBP 2015 Data Entry System Screens
#1b Inpatient Hospital Psychiatric – Base 4
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 20 of 239
PBP 2015 Data Entry System Screens
#1b Inpatient Hospital Psychiatric – Base 5
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 21 of 239
PBP 2015 Data Entry System Screens
#1b Inpatient Hospital Psychiatric – Base 6
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 22 of 239
PBP 2015 Data Entry System Screens
#1b Inpatient Hospital Psychiatric – Base 7
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 23 of 239
PBP 2015 Data Entry System Screens
#1b Inpatient Hospital Psychiatric – Base 8
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 24 of 239
PBP 2015 Data Entry System Screens
#1b Inpatient Hospital Psychiatric – Base 9
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 25 of 239
PBP 2015 Data Entry System Screens
#1b Inpatient Hospital Psychiatric – Base 10
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 26 of 239
PBP 2015 Data Entry System Screens
#1b Inpatient Hospital Psychiatric – Base 11
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 27 of 239
PBP 2015 Data Entry System Screens
#1b Inpatient Hospital Psychiatric – Base 12
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 28 of 239
PBP 2015 Data Entry System Screens
#1b Inpatient Hospital Psychiatric (B Only) – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 29 of 239
PBP 2015 Data Entry System Screens
#1b Inpatient Hospital Psychiatric (B Only) – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 30 of 239
PBP 2015 Data Entry System Screens
#1b Inpatient Hospital Psychiatric (B Only) – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 31 of 239
PBP 2015 Data Entry System Screens
#1b Inpatient Hospital Psychiatric (B Only) – Base 4
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 32 of 239
PBP 2015 Data Entry System Screens
#1b Inpatient Hospital Psychiatric (B Only) – Base 5
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 33 of 239
PBP 2015 Data Entry System Screens
#2 SNF – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 34 of 239
PBP 2015 Data Entry System Screens
#2 SNF – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 35 of 239
PBP 2015 Data Entry System Screens
#2 SNF – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 36 of 239
PBP 2015 Data Entry System Screens
#2 SNF – Base 4
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 37 of 239
PBP 2015 Data Entry System Screens
#2 SNF – Base 5
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 38 of 239
PBP 2015 Data Entry System Screens
#2 SNF – Base 6
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 39 of 239
PBP 2015 Data Entry System Screens
#2 SNF – Base 7
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 40 of 239
PBP 2015 Data Entry System Screens
#2 SNF (B Only) – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 41 of 239
PBP 2015 Data Entry System Screens
#2 SNF (B Only) – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 42 of 239
PBP 2015 Data Entry System Screens
#2 SNF (B Only) – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 43 of 239
PBP 2015 Data Entry System Screens
#2 SNF (B Only) – Base 4
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 44 of 239
PBP 2015 Data Entry System Screens
#3 Cardiac and Pulmonary Rehabilitation Services – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 45 of 239
PBP 2015 Data Entry System Screens
#3 Cardiac and Pulmonary Rehabilitation Services – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 46 of 239
PBP 2015 Data Entry System Screens
#3 Cardiac and Pulmonary Rehabilitation Services – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 47 of 239
PBP 2015 Data Entry System Screens
#3 Cardiac and Pulmonary Rehabilitation Services – Base 4
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 48 of 239
PBP 2015 Data Entry System Screens
#4a Emergency Care – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 49 of 239
PBP 2015 Data Entry System Screens
#4a Emergency Care – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 50 of 239
PBP 2015 Data Entry System Screens
#4b Urgently Needed Care – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 51 of 239
PBP 2015 Data Entry System Screens
#4b Urgently Needed Care – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 52 of 239
PBP 2015 Data Entry System Screens
#4b Urgently Needed Care – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 53 of 239
PBP 2015 Data Entry System Screens
#4c Worldwide Emergency Coverage – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 54 of 239
PBP 2015 Data Entry System Screens
#4c Worldwide Emergency Coverage – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 55 of 239
PBP 2015 Data Entry System Screens
#4c Worldwide Emergency Coverage – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 56 of 239
PBP 2015 Data Entry System Screens
#5 Partial Hospitalization – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 57 of 239
PBP 2015 Data Entry System Screens
#5 Partial Hospitalization – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 58 of 239
PBP 2015 Data Entry System Screens
#6 Home Health Services – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 59 of 239
PBP 2015 Data Entry System Screens
#6 Home Health Services – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 60 of 239
PBP 2015 Data Entry System Screens
#6 Home Health Services – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 61 of 239
PBP 2015 Data Entry System Screens
#6 Home Health Services – MMP – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 62 of 239
PBP 2015 Data Entry System Screens
#6 Home Health Services – MMP – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 63 of 239
PBP 2015 Data Entry System Screens
#6 Home Health Services – MMP – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 64 of 239
PBP 2015 Data Entry System Screens
#7a Primary Care Physician Services – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 65 of 239
PBP 2015 Data Entry System Screens
#7a Primary Care Physician Services – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 66 of 239
PBP 2015 Data Entry System Screens
#7b Chiropractic Services – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 67 of 239
PBP 2015 Data Entry System Screens
#7b Chiropractic Services – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 68 of 239
PBP 2015 Data Entry System Screens
#7b Chiropractic Services – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 69 of 239
PBP 2015 Data Entry System Screens
#7b Chiropractic Services – Base 4
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 70 of 239
PBP 2015 Data Entry System Screens
#7c Occupational Therapy Services – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 71 of 239
PBP 2015 Data Entry System Screens
#7c Occupational Therapy Services – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 72 of 239
PBP 2015 Data Entry System Screens
#7c Occupational Therapy Services – MMP – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 73 of 239
PBP 2015 Data Entry System Screens
#7c Occupational Therapy Services – MMP – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 74 of 239
PBP 2015 Data Entry System Screens
#7d Physician Specialist Services – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 75 of 239
PBP 2015 Data Entry System Screens
#7d Physician Specialist Services – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 76 of 239
PBP 2015 Data Entry System Screens
#7e Mental Health Specialty Services – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 77 of 239
PBP 2015 Data Entry System Screens
#7e Mental Health Specialty Services – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 78 of 239
PBP 2015 Data Entry System Screens
#7e Mental Health Specialty Services – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 79 of 239
PBP 2015 Data Entry System Screens
#7f Podiatry Services – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 80 of 239
PBP 2015 Data Entry System Screens
#7f Podiatry Services – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 81 of 239
PBP 2015 Data Entry System Screens
#7f Podiatry Services – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 82 of 239
PBP 2015 Data Entry System Screens
#7g Other Health Care Professional – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 83 of 239
PBP 2015 Data Entry System Screens
#7g Other Health Care Professional – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 84 of 239
PBP 2015 Data Entry System Screens
#7h Psychiatric Services – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 85 of 239
PBP 2015 Data Entry System Screens
#7h Psychiatric Services – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 86 of 239
PBP 2015 Data Entry System Screens
#7h Psychiatric Services – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 87 of 239
PBP 2015 Data Entry System Screens
#7i PT and SP Services – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 88 of 239
PBP 2015 Data Entry System Screens
#7i PT and SP Services – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 89 of 239
PBP 2015 Data Entry System Screens
#7i PT and ST – MMP – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 90 of 239
PBP 2015 Data Entry System Screens
#7i PT and ST – MMP – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 91 of 239
PBP 2015 Data Entry System Screens
#8a Outpatient Diag Procs/Tests/Lab Services – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 92 of 239
PBP 2015 Data Entry System Screens
#8a Outpatient Diag Procs/Tests/Lab Services – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 93 of 239
PBP 2015 Data Entry System Screens
#8a Outpatient Diag Procs/Tests/Lab Services – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 94 of 239
PBP 2015 Data Entry System Screens
#8a Outpatient Diag Procs/Tests/Lab Services – Base 4
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 95 of 239
PBP 2015 Data Entry System Screens
#8b Outpatient Diag/Therapeutic Rad Services – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 96 of 239
PBP 2015 Data Entry System Screens
#8b Outpatient Diag/Therapeutic Rad Services – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 97 of 239
PBP 2015 Data Entry System Screens
#8b Outpatient Diag/Therapeutic Rad Services – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 98 of 239
PBP 2015 Data Entry System Screens
#9a Outpatient Hospital Services – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 99 of 239
PBP 2015 Data Entry System Screens
#9a Outpatient Hospital Services – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 100 of 239
PBP 2015 Data Entry System Screens
#9a Outpatient Hospital Services – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 101 of 239
PBP 2015 Data Entry System Screens
#9b ASC Services – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 102 of 239
PBP 2015 Data Entry System Screens
#9b ASC Services – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 103 of 239
PBP 2015 Data Entry System Screens
#9b ASC Services – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 104 of 239
PBP 2015 Data Entry System Screens
#9c Outpatient Substance Abuse – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 105 of 239
PBP 2015 Data Entry System Screens
#9c Outpatient Substance Abuse – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 106 of 239
PBP 2015 Data Entry System Screens
#9c Outpatient Substance Abuse – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 107 of 239
PBP 2015 Data Entry System Screens
#9d Outpatient Blood Services – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 108 of 239
PBP 2015 Data Entry System Screens
#9d Outpatient Blood Services – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 109 of 239
PBP 2015 Data Entry System Screens
#10a Ambulance Services – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 110 of 239
PBP 2015 Data Entry System Screens
#10a Ambulance Services – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 111 of 239
PBP 2015 Data Entry System Screens
#10b Transportation Services – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 112 of 239
PBP 2015 Data Entry System Screens
#10b Transportation Services – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 113 of 239
PBP 2015 Data Entry System Screens
#10b Transportation Services – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 114 of 239
PBP 2015 Data Entry System Screens
#11a DME – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 115 of 239
PBP 2015 Data Entry System Screens
#11a DME – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 116 of 239
PBP 2015 Data Entry System Screens
#11a DME – MMP ‐ Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 117 of 239
PBP 2015 Data Entry System Screens
#11a DME – MMP ‐ Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 118 of 239
PBP 2015 Data Entry System Screens
#11b Prosthetic/Medical Supplies – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 119 of 239
PBP 2015 Data Entry System Screens
#11b Prosthetic/Medical Supplies – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 120 of 239
PBP 2015 Data Entry System Screens
#11b Prosthetic/Medical Supplies – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 121 of 239
PBP 2015 Data Entry System Screens
#11b Prosthetic/Medical Supplies – MMP ‐ Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 122 of 239
PBP 2015 Data Entry System Screens
#11c Diabetic Supplies and Services – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 123 of 239
PBP 2015 Data Entry System Screens
#11c Diabetic Supplies and Services – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 124 of 239
PBP 2015 Data Entry System Screens
#12 End Stage Renal Disease – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 125 of 239
PBP 2015 Data Entry System Screens
#12 End Stage Renal Disease – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 126 of 239
PBP 2015 Data Entry System Screens
#13a Acupuncture and Other Alternative Therapies – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 127 of 239
PBP 2015 Data Entry System Screens
#13a Acupuncture and Other Alternative Therapies – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 128 of 239
PBP 2015 Data Entry System Screens
#13a Acupuncture and Other Alternative Therapies – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 129 of 239
PBP 2015 Data Entry System Screens
#13b OTC Items – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 130 of 239
PBP 2015 Data Entry System Screens
#13b OTC Items – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 131 of 239
PBP 2015 Data Entry System Screens
#13b OTC Items – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 132 of 239
PBP 2015 Data Entry System Screens
#13c Meal Benefit – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 133 of 239
PBP 2015 Data Entry System Screens
#13c Meal Benefit – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 134 of 239
PBP 2015 Data Entry System Screens
#13c Meal Benefit – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 135 of 239
PBP 2015 Data Entry System Screens
#13d Other 1 – Base1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 136 of 239
PBP 2015 Data Entry System Screens
#13d Other 1 – Base2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 137 of 239
PBP 2015 Data Entry System Screens
#13d Other 1 – Base3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 138 of 239
PBP 2015 Data Entry System Screens
#13e Other 2 – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 139 of 239
PBP 2015 Data Entry System Screens
#13e Other 2 – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 140 of 239
PBP 2015 Data Entry System Screens
#13e Other 2 – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 141 of 239
PBP 2015 Data Entry System Screens
#13f Other 3 – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 142 of 239
PBP 2015 Data Entry System Screens
#13f Other 3 – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 143 of 239
PBP 2015 Data Entry System Screens
#13f Other 3 – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 144 of 239
PBP 2015 Data Entry System Screens
#13g Dual Eligible SNPs with Highly Integrated Services – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 145 of 239
PBP 2015 Data Entry System Screens
#13g Dual Eligible SNPs with Highly Integrated Services – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 146 of 239
PBP 2015 Data Entry System Screens
#13g Dual Eligible SNPs with Highly Integrated Services – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 147 of 239
PBP 2015 Data Entry System Screens
#13h Additional Services – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 148 of 239
PBP 2015 Data Entry System Screens
#13h Additional Services – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 149 of 239
PBP 2015 Data Entry System Screens
#13h Additional Services – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 150 of 239
PBP 2015 Data Entry System Screens
#13h Additional Services – Base 4
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 151 of 239
PBP 2015 Data Entry System Screens
#13h Additional Services – Base 5
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 152 of 239
PBP 2015 Data Entry System Screens
#13h Additional Services – Base 6
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 153 of 239
PBP 2015 Data Entry System Screens
#13h Additional Services – Base 7
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 154 of 239
PBP 2015 Data Entry System Screens
#13h Additional Services – Base 8
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 155 of 239
PBP 2015 Data Entry System Screens
#13h Additional Services – Base 9
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 156 of 239
PBP 2015 Data Entry System Screens
#13h Additional Services – Base 10
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 157 of 239
PBP 2015 Data Entry System Screens
#13h Additional Services – Base 11
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 158 of 239
PBP 2015 Data Entry System Screens
#13h Additional Services – Base 12
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 159 of 239
PBP 2015 Data Entry System Screens
#13h Additional Services – Base 13
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 160 of 239
PBP 2015 Data Entry System Screens
#13h Additional Services – Base 14
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 161 of 239
PBP 2015 Data Entry System Screens
#13h Additional Services – Base 15
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 162 of 239
PBP 2015 Data Entry System Screens
#13h Additional Services – Base 16
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 163 of 239
PBP 2015 Data Entry System Screens
#13h Additional Services – Base 17
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 164 of 239
PBP 2015 Data Entry System Screens
#13h Additional Services – Base 18
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 165 of 239
PBP 2015 Data Entry System Screens
#13h Additional Services – Base 19
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 166 of 239
PBP 2015 Data Entry System Screens
#13h Additional Services – Base 20
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 167 of 239
PBP 2015 Data Entry System Screens
#13h Additional Services – Base 21
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 168 of 239
PBP 2015 Data Entry System Screens
#13h Additional Services – Base 22
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 169 of 239
PBP 2015 Data Entry System Screens
#13h Additional Services – Base 23
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 170 of 239
PBP 2015 Data Entry System Screens
#13h Additional Services – Base 24
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 171 of 239
PBP 2015 Data Entry System Screens
#13h Additional Services – Base 25
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 172 of 239
PBP 2015 Data Entry System Screens
#13h Additional Services – Base 26
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 173 of 239
PBP 2015 Data Entry System Screens
#14a Medicare‐covered Preventive Services
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 174 of 239
PBP 2015 Data Entry System Screens
#14b Annual Physical Exam – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 175 of 239
PBP 2015 Data Entry System Screens
#14b Annual Physical Exam – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 176 of 239
PBP 2015 Data Entry System Screens
#14b Annual Physical Exam – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 177 of 239
PBP 2015 Data Entry System Screens
#14c Eligible Supplemental Benefits as Defined in Chapter 4 – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 178 of 239
PBP 2015 Data Entry System Screens
#14c Eligible Supplemental Benefits as Defined in Chapter 4 – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 179 of 239
PBP 2015 Data Entry System Screens
#14c Eligible Supplemental Benefits as Defined in Chapter 4 – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 180 of 239
PBP 2015 Data Entry System Screens
#14c Eligible Supplemental Benefits as Defined in Chapter 4 – Base 4
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 181 of 239
PBP 2015 Data Entry System Screens
#14c Eligible Supplemental Benefits as Defined in Chapter 4 – Base 5
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 182 of 239
PBP 2015 Data Entry System Screens
#14c Eligible Supplemental Benefits as Defined in Chapter 4 – Base 6
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 183 of 239
PBP 2015 Data Entry System Screens
#14c Eligible Supplemental Benefits as Defined in Chapter 4 – Base 7
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 184 of 239
PBP 2015 Data Entry System Screens
#14d – Kidney Disease Education Services Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 185 of 239
PBP 2015 Data Entry System Screens
#14d – Kidney Disease Education Services Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 186 of 239
PBP 2015 Data Entry System Screens
#14d – Kidney Disease Education Services Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 187 of 239
PBP 2015 Data Entry System Screens
#14e Diabetes Self‐Management Training – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 188 of 239
PBP 2015 Data Entry System Screens
#14e Diabetes Self‐Management Training – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 189 of 239
PBP 2015 Data Entry System Screens
#14e Diabetes Self‐Management Training – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 190 of 239
PBP 2015 Data Entry System Screens
#15 Medicare Part B Rx Drugs – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 191 of 239
PBP 2015 Data Entry System Screens
#15 Medicare Part B Rx Drugs – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 192 of 239
PBP 2015 Data Entry System Screens
#15 Medicare Part B Rx Drugs – Notes (Optional)
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 193 of 239
PBP 2015 Data Entry System Screens
#15 Home Infusion Bundled Services
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 194 of 239
PBP 2015 Data Entry System Screens
#16a Preventive Dental – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 195 of 239
PBP 2015 Data Entry System Screens
#16a Preventive Dental – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 196 of 239
PBP 2015 Data Entry System Screens
#16a Preventive Dental – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 197 of 239
PBP 2015 Data Entry System Screens
#16a Preventive Dental – Base 4
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 198 of 239
PBP 2015 Data Entry System Screens
#16a Preventive Dental – Base 5
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 199 of 239
PBP 2015 Data Entry System Screens
#16b Comprehensive Dental – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 200 of 239
PBP 2015 Data Entry System Screens
#16b Comprehensive Dental – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 201 of 239
PBP 2015 Data Entry System Screens
#16b Comprehensive Dental – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 202 of 239
PBP 2015 Data Entry System Screens
#16b Comprehensive Dental – Base 4
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 203 of 239
PBP 2015 Data Entry System Screens
#16b Comprehensive Dental – Base 5
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 204 of 239
PBP 2015 Data Entry System Screens
#16b Comprehensive Dental – Base 6
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 205 of 239
PBP 2015 Data Entry System Screens
#17a Eye Exams – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 206 of 239
PBP 2015 Data Entry System Screens
#17a Eye Exams – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 207 of 239
PBP 2015 Data Entry System Screens
#17a Eye Exams – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 208 of 239
PBP 2015 Data Entry System Screens
#17b Eyewear – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 209 of 239
PBP 2015 Data Entry System Screens
#17b Eyewear – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 210 of 239
PBP 2015 Data Entry System Screens
#17b Eyewear – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 211 of 239
PBP 2015 Data Entry System Screens
#17b Eyewear – Base 4
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 212 of 239
PBP 2015 Data Entry System Screens
#17b Eyewear – Base 5
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 213 of 239
PBP 2015 Data Entry System Screens
#17b Eyewear – Base 6
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 214 of 239
PBP 2015 Data Entry System Screens
#18a Hearing Exams – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 215 of 239
PBP 2015 Data Entry System Screens
#18a Hearing Exams – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 216 of 239
PBP 2015 Data Entry System Screens
#18a Hearing Exams – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 217 of 239
PBP 2015 Data Entry System Screens
#18a Hearing Exams – Base 4
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 218 of 239
PBP 2015 Data Entry System Screens
#18b Hearing Aids – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 219 of 239
PBP 2015 Data Entry System Screens
#18b Hearing Aids – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 220 of 239
PBP 2015 Data Entry System Screens
#18b Hearing Aids – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 221 of 239
PBP 2015 Data Entry System Screens
#18b Hearing Aids – Base 4
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 222 of 239
PBP 2015 Data Entry System Screens
#18b Hearing Aids – Base 5
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 223 of 239
PBP 2015 Data Entry System Screens
#20 Outpatient Drugs – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 224 of 239
PBP 2015 Data Entry System Screens
#20 Outpatient Drugs – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 225 of 239
PBP 2015 Data Entry System Screens
#20 Outpatient Drugs – Base 3
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 226 of 239
PBP 2015 Data Entry System Screens
#20 Outpatient Drugs – Base 4
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 227 of 239
PBP 2015 Data Entry System Screens
#20 Outpatient Drugs – Notes (Optional)
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 228 of 239
PBP 2015 Data Entry System Screens
#20 Outpatient Drugs – Group 1 – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 229 of 239
PBP 2015 Data Entry System Screens
#20 Outpatient Drugs – Group 1 – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 230 of 239
PBP 2015 Data Entry System Screens
#20 Outpatient Drugs – Group 2 – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 231 of 239
PBP 2015 Data Entry System Screens
#20 Outpatient Drugs – Group 2 – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 232 of 239
PBP 2015 Data Entry System Screens
#20 Outpatient Drugs – Group 3 – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 233 of 239
PBP 2015 Data Entry System Screens
#20 Outpatient Drugs – Group 3 – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 234 of 239
PBP 2015 Data Entry System Screens
#20 Outpatient Drugs – Group 4 – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 235 of 239
PBP 2015 Data Entry System Screens
#20 Outpatient Drugs – Group 4 – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 236 of 239
PBP 2015 Data Entry System Screens
#20 Outpatient Drugs – Group 5 – Base 1
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 237 of 239
PBP 2015 Data Entry System Screens
#20 Outpatient Drugs – Group 5 – Base 2
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 238 of 239
PBP 2015 Data Entry System Screens
#20 Home Infusion Bundled Services
Fu Associates, Ltd.
CY 2015 PBP – Section B
12/20/2013
CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
Page 239 of 239
| File Type | application/pdf |
| File Title | Microsoft Word - PBP_2015_screenshots_section_b_2013_12_19.docx |
| Author | bloss |
| File Modified | 2013-12-20 |
| File Created | 2013-12-20 |