Official Federal Forms
Centers For Medicare And Medicaid Services
Last updated: 9/21/2024
Independent Diagnostic Testing Facilities-Site Investigation {CMS-10221}
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Description
CMS-10221 - INDEPENDENT DIAGNOSTIC TESTING FACILITIES—SITE INVESTIGATION 42 CFR § 410.33. This form is a worksheet used to record the results of Medicare site visits to Independent Diagnostic Testing Facilities (IDTFs). The form is used to verify that IDTFs comply with certain performance standards. These standards include proper medical record storage, which requires IDTFs to retrieve records within two business days if requested, and allowing unannounced inspections by CMS or its contractors. The form contains questions regarding the facility's accessibility during regular business hours and its posted hours of operation. It also includes sections where "Assumes responsibility" boxes must be checked, and each supervisory physician listed must complete and sign a separate attestation statement. www.FormsWorkflow.com
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