The Code of Federal Regulations of the United States of AmericaU.S. Government Printing Office, 1983 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. |
Contents
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Common terms and phrases
administrative law judge agreement allowable cost amended amount amount in controversy ance Appeals Council applicable appropriate approved assets basis benefits carrier certification claim clinic coinsurance contract cost reporting period coverage decision deductible dialysis effective eligible end-stage renal disease enrollees enrollment entitled equipment Federal filed HCFA Health Care Financing health insurance health insurance program health services HMO's ices individual initial determination intermediary items and services items or services laboratory Medi Medicaid Medicare meet ment month notice organization outpatient participation party patient percent person personnel physi physical therapy physician policies premiums procedures prospective payment provider of services provider's qualified reasonable cost Redesignated at 42 reim reimbursement renal renal dialysis request requirements Secretary Sept services furnished skilled nursing facility Social Security Act Social Security Administration speech pathology Standard Subpart supplementary medical insurance supplier surgical termination tient tion treatment utilization review
Popular passages
Page 79 - XVIII of the Act with respect to any item or service to the extent that payment has been made, or can reasonably be expected to be made, under a workmen's compensation law or plan of the United States or a State.
Page 235 - ... 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 478 - Security for the purpose of reviewing the status of the Federal OldAge and Survivors Insurance Trust Fund, the Federal Disability Insurance Trust Fund, the Federal Hospital Insurance Trust Fund...
Page 53 - ... (b) An agreement entered into with any State pursuant to subsection (a) may be applicable to either of the following coverage groups : ( 1 ) individuals receiving money payments under the plan of such State approved under title I or title XVI ; or (2) individuals receiving money payments under all of the plans of such State approved under titles, I, X, XIV, and XVI, and part A of title IV.
Page 286 - Has direct responsibility for the organization and administration of the medical staff, in accordance with the terms of the medical staff constitution, bylaws, rules, and regulations; (ii) In all medico-administrative matters, acts in coordination and cooperation with the hospital administrator in giving effect to the policies adopted by the governing body; and (iii) Is responsible for the functioning of the clinical organization of the hospital and keeps or causes to be kept careful supervision...
Page 76 - 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 200 - 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 408 - ... (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 254 - ... and regulations, or who shall with intent to defraud, in any manner willfully and knowingly deceive, mislead, or threaten any claimant or prospective claimant, by word, circular, letter, or by advertisement.
Page 347 - For purposes of clause (1) of the preceding sentence, the cost of the studies, surveys, designs, plans, working drawings, specifications, and other activities essential to the acquisition, improvement, expansion, or replacement of the plant and equipment with respect to which such expenditure is made shall be included in determining whether such expenditure exceeds $100,000.