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 17
... charges . ( a ) Statement of policy . It is HCFA's policy to comply with certain requests for information services without charge . Except as otherwise deter- mined pursuant to paragraph ( c ) of this section , fees will be charged for ...
... charges . ( a ) Statement of policy . It is HCFA's policy to comply with certain requests for information services without charge . Except as otherwise deter- mined pursuant to paragraph ( c ) of this section , fees will be charged for ...
Page 39
... charges . 405.503 Determining customary charges . 405.504 Determining prevailing charges . 405.505 Determination of locality 405.506 Charges higher than customary or prevailing charges or lowest charge lev- els . 405.507 Illustrations ...
... charges . 405.503 Determining customary charges . 405.504 Determining prevailing charges . 405.505 Determination of locality 405.506 Charges higher than customary or prevailing charges or lowest charge lev- els . 405.507 Illustrations ...
Page 48
... charges on overpay . ment and underpayments to provid- ers , suppliers , and other entities . ( a ) Basis and purpose ... charge interest on overpayments , and pay in- terest on underpayments , to providers and suppliers of services ...
... charges on overpay . ment and underpayments to provid- ers , suppliers , and other entities . ( a ) Basis and purpose ... charge interest on overpayments , and pay in- terest on underpayments , to providers and suppliers of services ...
Page 49
... charge will be applied to any balance . ) ( c ) Definition of final determination . ( 1 ) For purposes of this section , any of the following constitutes a final deter- mination : ( i ) A Notice of Amount of Program Reimbursement ( NPR ) ...
... charge will be applied to any balance . ) ( c ) Definition of final determination . ( 1 ) For purposes of this section , any of the following constitutes a final deter- mination : ( i ) A Notice of Amount of Program Reimbursement ( NPR ) ...
Page 50
... charges will be waived if the overpayment or underpayment is completely liquidated within 30 days from the date of the final determina- tion . ( ii ) HCFA may waive interest charges if it determines that the administra- tive cost of ...
... charges will be waived if the overpayment or underpayment is completely liquidated within 30 days from the date of the final determina- tion . ( ii ) HCFA may waive interest charges if it determines that the administra- tive cost of ...
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...