Claims Manual, Parts 11-13U.S. Social Security Administration, 1981 |
From inside the book
Results 1-5 of 33
Page 4
... DEDUCTIBLES AND COINSURANCE Inpatient Hospital Deductible Inpatient Hospital Coinsurance Extended Care Coinsurance 11192 11193 11194 PART V - PROVIDER COST LIMITS Provider Cost Limits 11196 Part A Blood Deductible . 11195 TN 3906 ( SR ...
... DEDUCTIBLES AND COINSURANCE Inpatient Hospital Deductible Inpatient Hospital Coinsurance Extended Care Coinsurance 11192 11193 11194 PART V - PROVIDER COST LIMITS Provider Cost Limits 11196 Part A Blood Deductible . 11195 TN 3906 ( SR ...
Page 10
... deductible and coinsurance , see § 11178 and § 11180 respectively . ) 11118.1 Guarantee of Payment Provision ( a ) General Under the guarantee of payment provision , a participating hospital may be paid on behalf of a beneficiary whose ...
... deductible and coinsurance , see § 11178 and § 11180 respectively . ) 11118.1 Guarantee of Payment Provision ( a ) General Under the guarantee of payment provision , a participating hospital may be paid on behalf of a beneficiary whose ...
Page 10
... deductible , ( C ) the 60 lifetime reserve days at one half the inpatient hospital deductible . Benefit days , including lifetime days , not available to the patient because of the psychiatric reduction nevertheless remain available for ...
... deductible , ( C ) the 60 lifetime reserve days at one half the inpatient hospital deductible . Benefit days , including lifetime days , not available to the patient because of the psychiatric reduction nevertheless remain available for ...
Page 10
... deductible or coinsurance requirement , the inpatient day ( s ) used in satisfying these requirements nevertheless counts toward the beneficiary's maximum inpatient days . Similarly , inpatient psychiatric hospital services count toward ...
... deductible or coinsurance requirement , the inpatient day ( s ) used in satisfying these requirements nevertheless counts toward the beneficiary's maximum inpatient days . Similarly , inpatient psychiatric hospital services count toward ...
Page 15
... Deductible The beneficiary is responsible for a deductible amount before the program begins paying for inpatient hospital services in each benefit period . The Secretary determines the amount of the deductible applicable for each year ...
... Deductible The beneficiary is responsible for a deductible amount before the program begins paying for inpatient hospital services in each benefit period . The Secretary determines the amount of the deductible applicable for each year ...
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...