The Code of Federal Regulations of the United States of AmericaU.S. Government Printing Office, 1994 The Code of Federal Regulations is the codification of the general and permanent rules published in the Federal Register by the executive departments and agencies of the Federal Government. |
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Page 15
... carriers , and State agencies ) . The lat- est Contract Performance Review Re- port pertaining to a particular intermediary or carrier , prepared prior to February 1 , 1973 , may also be dis- closed to any person upon request in writing ...
... carriers , and State agencies ) . The lat- est Contract Performance Review Re- port pertaining to a particular intermediary or carrier , prepared prior to February 1 , 1973 , may also be dis- closed to any person upon request in writing ...
Page 16
... carrier . ( c ) The following information may be released to any officer or employee of an agency of the Federal or a State government lawfully charged with the duty of conducting an investigation or prosecution with respect to possible ...
... carrier . ( c ) The following information may be released to any officer or employee of an agency of the Federal or a State government lawfully charged with the duty of conducting an investigation or prosecution with respect to possible ...
Page 39
... carrier . 405.374 Collection and compromise of claims for overpayments . 405.375 Withholding Medicare payments to ... Carriers ' procedural terminology and coding systems . 405.515 Reimbursement for clinical labora- tory services billed ...
... carrier . 405.374 Collection and compromise of claims for overpayments . 405.375 Withholding Medicare payments to ... Carriers ' procedural terminology and coding systems . 405.515 Reimbursement for clinical labora- tory services billed ...
Page 40
... carrier hearing officer . 405.825 Location of carrier hearing . 405.826 405.830 Notice of carrier hearing . Conduct of the carrier hearing . 405.831 Waiver of right to appear and present evidence . 405.832 Dismissal of request for carrier ...
... carrier hearing officer . 405.825 Location of carrier hearing . 405.826 405.830 Notice of carrier hearing . Conduct of the carrier hearing . 405.831 Waiver of right to appear and present evidence . 405.832 Dismissal of request for carrier ...
Page 43
... carrier , the intermediary , or the Health Care Financing Administration that more than the correct amount was paid was made subsequent to the third year following the year in which notice was sent to such individual that such amount ...
... carrier , the intermediary , or the Health Care Financing Administration that more than the correct amount was paid was made subsequent to the third year following the year in which notice was sent to such individual that such amount ...
Common terms and phrases
adjustment administrative agency agreement allowable costs amended at 58 amount in controversy applicable approved assets basis carrier chapter clinic CMP's coinsurance contract cost reporting period coverage deductible depreciation deter determination dialysis discharge durable medical equipment eligible employees entity ESRD facility fee schedule ficiaries filed fiscal funds HCFA health benefits health maintenance organization health services hearing HMO or CMP HMO's hospice care hospital's ices individual initial inpatient hospital intermediary July 15 limits Medi Medicaid Medicare enrollees Medicare payment meet ment month nished notice nurse October outpatient paid party patient percent physi physical therapy physician pital premiums procedures prospective payment prospective payment system provider reasonable cost Redesignated reimbursement renal renal dialysis reporting periods beginning request requirements riod RPCH Sept services furnished Social Security specified in paragraph subpart supplier termination therapy tient tion vider
Popular passages
Page 241 - Notwithstanding any other provisions of this title, no payment may be made under part A or part B for any expenses incurred for items or services — (1) which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member...
Page 172 - States or (B) an alien lawfully admitted for permanent residence who has resided in the United States (as...
Page 103 - ... (4) in the case of an agency or organization in any State in which State or applicable local law provides for the licensing of agencies or organizations of this nature, (A) is licensed pursuant to such law, or (B) is approved, by the agency of such State or locality responsible for licensing...
Page 86 - ... he may institute for the United States, or in the name of the United States, an action in a district court of the United States, in accordance with sections 1391 through 1393 of title 28, United States Code, for a restraining order, a preliminary or permanent injunction, or such other order as he deems appropriate.
Page 254 - ... (12) where such expenses are for services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth. (b) Payment under this title may not be made with respect to any item or service to the extent that payment has been made, or can reasonably be expected to be made (as determined in accordance with regulations), with respect to such item or service, under a workmen's compensation law or plan of the United States or a State.
Page 363 - The objective is that under the methods of determining costs, the costs with respect to individuals covered by the program will not be borne by individuals not so covered, and the costs with respect to individuals not so covered will not be borne by the program.
Page 46 - The standards set forth in this chapter do not apply to the handling of any claim as to which there is an indication of fraud, the presentation of a false claim, or misrepresentation on the part of the debtor or any other party having an interest in the claim, or to any claim based in whole or in part on conduct in violation of the antitrust laws.
Page 493 - ... shall maintain such books and related records as will facilitate an effective audit in such detail and in such manner as shall be prescribed by the Office, and such books and records...
Page 60 - In determining the reasonable charge for services for purposes of this paragraph, there shall be taken into consideration the customary charges for similar services generally made by the physician or other person furnishing such services, as well as the prevailing charges in the locality for similar services.
Page 207 - ... (5) the services of a private-duty nurse or other private-duty attendant. Paragraph (4) shall not apply to services provided in a hospital by — (6) an intern or a resident-in-training under a teaching program approved by the Council on Medical Education of the American Medical Association or, in the case of an osteopathic hospital, approved by the Committee on Hospitals of the Bureau of Professional Education of the American Osteopathic Association...