Claims Manual, Parts 11-13U.S. Social Security Administration, 1981 |
From inside the book
Results 1-5 of 35
Page 8
... Carriers consult with PSRO's to obtain in- formation they gathered on a sample basis as to whether X - rays and diagnostic tests are specifically ordered as described in ( 1 ) above . 11104. Bed and Board ( a ) General Effective for ...
... Carriers consult with PSRO's to obtain in- formation they gathered on a sample basis as to whether X - rays and diagnostic tests are specifically ordered as described in ( 1 ) above . 11104. Bed and Board ( a ) General Effective for ...
Page 15
... carriers of those physical therapists who are qualified and hold the required Medicare credentials . ( b ) ... carrier has primary responsibility for determining reasonable charges . The reasonable charge determinations made by ...
... carriers of those physical therapists who are qualified and hold the required Medicare credentials . ( b ) ... carrier has primary responsibility for determining reasonable charges . The reasonable charge determinations made by ...
Page 16
... carrier . Other factors that are necessary and appropriate with respect to a specific item or service are taken into account . The income of the individual patient may not be considered in determining the amount of the reasonable charge ...
... carrier . Other factors that are necessary and appropriate with respect to a specific item or service are taken into account . The income of the individual patient may not be considered in determining the amount of the reasonable charge ...
Page 17
... carrier can verify this through its claims records and / or information furnished by the physician or other person , it may take this factor into account in determining whether unusual circumstances are present in a particular case ...
... carrier can verify this through its claims records and / or information furnished by the physician or other person , it may take this factor into account in determining whether unusual circumstances are present in a particular case ...
Page 18
... carrier cannot derive precise data on the frequency of services from its records , it may use any information it has about the volume of business done by various suppliers in its area in order to weight the customary charges used to ...
... carrier cannot derive precise data on the frequency of services from its records , it may use any information it has about the volume of business done by various suppliers in its area in order to weight the customary charges used to ...
Common terms and phrases
application Background This transmittal beneficiary benefit period carrier Claims Manual CM clinic coinsurance Contents CM cost customary charge Delete deny-(see Department of Health determination diagnostic dialysis discharge Divider for CM drug durable medical equipment eligibility Explanation of Manual extended care services facility File the Conversion Health and Human home health services home health visits Human Services Social individual inpatient hospital services institution limited basis Medicaid medical necessity Medicare occupational therapy Office of Operational Operational Policy Originating Office outpatient patient patient's condition physical therapy physician Policy and Procedures POMS chapter POMS Conversion Chart presumed coverage Procedures Effective Date Program Service Centers provider psychiatric hospital qualified reasonable charge recipient RECONR redetermination reimbursement Security Administration Office services furnished Services Social Security skilled nursing service Social Security Administration speech pathology stay subchapter numbers supervision Supplemental Security Income Table of Contents teletype therapeutic therapist TSC-SR tuberculosis U.S. Department
Popular passages
Page 15 - Association, or, in the case of services in a hospital or osteopathic hospital by an intern or resident-in-training in the field of dentistry, approved by the Council on Dental Education of the American Dental Association. Inpatient Psychiatric Hospital Services (c) The term "inpatient psychiatric hospital services" means inpatient hospital services furnished to an inpatient of a psychiatric hospital.
Page 16 - ... except that such term shall not include a private organization which is not a nonprofit organization exempt from Federal income taxation under section 501 of the Internal Revenue Code of 1954 (or a subdivision of such organization) unless it is licensed pursuant to State law and it meets such...
Page 34 - 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 34 - ... (11) where such expenses constitute charges imposed by immediate relatives of such individual or members of his household ; (12) where such expenses are for services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth...
Page 26 - ... (1) is primarily engaged in providing to inpatients (A) skilled nursing care and related services for patients who require medical or nursing care, or (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons...
Page 15 - psychiatric hospital' means an institution which — "(1) is primarily engaged in providing, by or under the supervision of a physician, psychiatric services for the diagnosis and treatment of mentally ill persons...
Page 19 - Association, or jointly by the Council on Medical Education of the American Medical Association and the American Physical Therapy Association; or (2) Prior to January 1, 1966.
Page 34 - ... (7) ambulance service where the use of other methods of transportation is contraindicated by the individual's condition, but only to the extent provided in regulations; (8) prosthetic devices (other than dental) which replace all or part of an internal body organ, including replacement of such devices...
Page 15 - ... (4) has a requirement that every patient must be under the care of a physician; (5) provides 24-hour nursing service rendered or supervised by a registered professional nurse, and has a licensed practical nurse or registered professional nurse on duty at all times...
Page 34 - ... (2) a doctor of dentistry or of dental or oral surgery who is legally authorized to practice dentistry by the State in which he performs such function but only with respect to (A) surgery related to the jaw or any structure contiguous to the jaw or (B) the reduction of any fracture of the jaw or any facial bone...