Form Hfs 2316 PDF Details

Within the intricacies of healthcare administration, navigating the sea of paperwork can often seem daunting. Amidst this complex backdrop, one document emerges as a crucial tool for managing specific financial and operational tasks—the HFS 2316 form. Sanctioned by the State of Illinois Department of Healthcare and Family Services, this form acts as a limited power of attorney, granting a chosen agent the authority to sign off on crucial billing documents on behalf of a facility's administrator. Specifically, it covers the signing of the Billing Certification on the last page of Form HFS 194-M-1, Remittance Advice, and Form HFS 2234, the Bed Reserve Form. This designation not only streamlines certain administrative procedures but also places immense trust and responsibility in the hands of the appointed agent. The agent, typically an employee of the facility, is tasked with ensuring the accuracy of payments before making any endorsements. However, this power, while significant, is designed with a safeguard; it remains active only until the Illinois Department of Healthcare and Family Services is officially informed of its revocation in writing. Furthermore, it's critical to note that the authorization doesn't impact the rights, liabilities, or duties that the facility or the administrator has, especially concerning the provision of services under the Medical Assistance Program. Accepting this role, the administrator vouches for all payments received under their name, underscoring the importance of precision and accountability in this process. The HFS 2316 form, thus, is not just a piece of paper but a pivotal instrument in the management and operation of healthcare facilities, facilitating a smoother flow of administrative tasks while ensuring adherence to state regulations.

QuestionAnswer
Form NameForm Hfs 2316
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameshfs2316 hfs2316 form

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State of Illinois

Department of Healthcare and Family Services

LIMITED POWER OF ATTORNEY

I,

, do hereby make and appoint

 

Name of Facility's Administrator (Printed)

 

Name of Agent

as my true and lawful attorney in fact for me and in my name solely for the purpose of signing the Billing Certification located on the last page of Form HFS 194-M-1, Remittance Advice, and Form HFS 2234, Bed Reserve Form.

The agent is employed at the facility and will, before signing Form HFS 194-M-1, assure the accuracy of the payment received.

This limited power of attorney shall remain in effect until such time as the Illinois Department of Healthcare and Family Services is notified in writing that it has been revoked.

This authorization in no way limits the facility's or my rights, liabilities or duties relating to the provisions of service under the Illinois Department of Healthcare and Family Services Medical Assistance Program. I accept full responsibility for all payments received from the Illinois Department of Healthcare and Family Services under my name on Form HFS 194-M-1 and Form HFS 2234.

Name of Facility

Address of Facility

 

 

 

 

 

Signature of Facility Administrator

 

Date

 

 

 

 

 

Date

Signature of Agent

 

 

 

 

Printed Name of Agent

 

 

HFS 2316 ( R-11-09)

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1. Start filling out the Form Hfs 2316 with a group of major blanks. Get all the required information and ensure there's nothing left out!

Writing section 1 of Form Hfs 2316

2. The subsequent stage is to complete these particular blank fields: Address of Facility, Signature of Facility Administrator, Signature of Agent, Printed Name of Agent, Date, and Date.

Date, Signature of Facility Administrator, and Printed Name of Agent in Form Hfs 2316

Always be extremely attentive when completing Date and Signature of Facility Administrator, as this is the part in which many people make a few mistakes.

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