Title: Provider Disclosure on Patient Protections Against Balance Billing – Facility and Provider Agreements

Requirements Related to Surprise Billing: Qualifying Payment Amount, Notice and Consent, Disclosure on Patient Protections Against Balance Billing, and State Law Opt-in (CMS-10780)

OMB: 0938-1401

IC ID: 249145

Documents and Forms
Information Collection (IC) Details

© 2023 OMB.report | Privacy Policy