Medicare Financial Management Manual (Pub. 100-06), Ch. 6 § 70.16
Quarterly Periodic Interim Payment (PIP) Report - Form CMS-1566C
70.16 - Quarterly Periodic Interim Payment (PIP) Report - Form CMS-1566C
(Rev. 6, 08-30-02)
A3-3898.16
QUARTERLY PERIODIC INTERIM PAYMENT (PIP) REPORT
FORM CMS-1566C (CROWD FORM Q)
INTERMEDIARY NUMBER_______
REPORT PERIOD
PIP PROVIDERS
HOSP.
(1)
SNF
(2)
HHA
(3)
TOTAL
(4)
1. BEGINNING OF
QUARTER
2. ACCRETIONS
3. DELETIONS
4. END OF QUARTER