(4) Inpatient charges and revenues (classified by class of primary payer).

(5) Outpatient charges and revenues (classified by class of primary payer).

(6) Inpatient and outpatient hospital expenses (by cost center classified for operating and capital).

(7) Reasonable costs.
(8) Other income.

(9) Bad debt and charity care.
(10) Capital acquisitions.
(11) Capital assets.

(c) Due date for demonstration project cost report. Due dates for demonstration cost reports are established by HCFA through instructions but are no more often than the due dates specified in § 413.24(f) of this chapter for hospital cost reports.

(d) Interim reporting. Hospitals participating in the demonstration project are required to submit an interim report covering the first six months in which the hospital participates in the demonstration project. Hospitals are required to submit additional interim reports requested by HCFA on the due dates established by HCFA.

(e) Reporting format. Demonstration project cost reports must be submitted in an electronic format. The hospital's electronic programs must be capable of producing an output file compatible with their respective intermediary's automated systems.

§ 403.410 Payments to hospitals participating in the demonstration.

(a) General. Hospitals participating in the demonstration project are paid on a reasonable cost basis for 100 percent of the incremental costs (as defined in paragraph (b) of this section) incurred as a result of that participation. To prevent duplicate payments, payments made to a hospital under the provisions of this section are subtracted from the hospital's total allowable costs subject to cost finding and apportionment.

(b) Incremental costs. Incremental costs are those costs that are reasonable and can be identified directly as having been incurred solely because of participation in the demonstration project. They do not represent any of the same costs that are incurred by other hospitals not participating in the demonstration project or costs that would have otherwise been incurred by hospitals participating in the demonstration. These costs include those attributable to the collection, reporting, and electronic submission of the additional data specified in § 403.408(b). Incremental costs do not include those costs incurred because of the requirement in section 4007(b) of Public Law 100-203 for the electronic submission of annual cost reports.

PART 405-FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED

Subparts A and B [Reserved]

Subpart C-Recovery of Overpayments and Suspension of Payment

Sec.

405.301 Scope of subpart.

LIABILITY FOR PAYMENTS TO PROVIDERS AND SUPPLIERS, AND HANDLING OF INCORRECT PAYMENTS

405.350 Individual's liability for payments made to providers and other persons for items and services furnished the individual.

405.351 Incorrect payments for which the individual is not liable.

405.352 Adjustment of title XVIII incorrect payments.

405.353 Certification of amount that will

be adjusted against individual title II or railroad retirement benefits.

405.354 Procedures for adjustment or recovery-title II beneficiary. 405.355 Waiver of adjustment or recovery. 405.356 Principles applied in waiver of, adjustment or recovery.

405.359 Liability of certifying or disbursing officer.

405.502 Criteria for determining reasonable 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 levels.

405.507 Illustrations of the application of the criteria for determining reasonable charges.

405.508 Determination of comparable circumstances; limitation.

405.509 Determining the inflation-indexed charge.

405.511 Reasonable charges for medical services, supplies, and equipment. 405.512 Carriers' procedural terminology and coding systems.

405.514 Payment for durable medical equipment.

405.515 Reimbursement for clinical laboratory services billed by physicians. 405.520 Reimbursement for services of interns, residents and supervising physicians; general.

405.521 Services of attending physicians supervising interns and residents. 405.522 Interns' and residents' services in approved teaching programs.

405.523 Interns' and residents' services not in approved teaching programs. 405.524 Interns' and residents' services outside the hospital.

405.525 Basis of reimbursement to providers under the health insurance program for services of interns and residents.

405.530 Payment of radiologist services under a fee schedule.

405.531 Basic methodology for calculating radiology fee schedules for calendar year 1989.

405.532 Calculating radiology fee schedules for calendar years after 1989. 405.533 Special rules for nonparticipating physicians furnishing radiology services. SERVICES OF PHYSICIANS IN PROVIDERS 405.550 Conditions for payment of charges for physician services to patients in providers: General provisions. 405.551 Payment of charges for physician

services in providers: General provisions. 405.552 Conditions for payment of charges: Anesthesiology services.

405.553 Reasonable charges for anesthesiology services.

405.554 Conditions for payment of charges: Radiology services.

405.555 Payment of charges for radiology services.

405.556 Conditions for payment of charges: Physician laboratory services. 405.557 Reasonable charges for physician laboratory services.

405.580 Conditions of payment for assistants at surgery in teaching hospitals.

Subpart F [Reserved]

Subpart G-Reconsiderations and Appeals Under Medicare Part A

405.701 Basis and purpose. 405.702

Notice of initial determination. 405.704 Actions which are initial determi

nations.

405.705 Actions which are not initial determinations.

405.706 Decisions of utilization review com

mittees.

405.708 Effect of initial determination. 405.710 Right to reconsideration.

405.711 Time and place of filing request for reconsideration.

405.712 Extension of time to request recon

sideration.

405.714 Withdrawal of request for recon

sideration.

405.715 Reconsidered determination.

405.716 Notice of reconsidered determination.

405.717 Effect of a reconsidered determination.

405.718 Expedited appeals process; conditions for use of such process. 405.718a Expedited appeals process; place and time of filing request. 405.718b Expedited appeals process; parties.

405.718c Expedited appeals process; agreement requirements.

405.718d Expedited appeals process; effect of agreement.

Subpart Q-Conditions of Participation: Clinics, Rehabilitation Agencies, and Public Health Agencies as Providers of Outpatient Physical Therapy and/or Speech Pathology Services; and Conditions for Coverage: Outpatient Physical Therapy Services Furnished by Physical Therapists in Independent Practice

CONDITIONS OF PARTICIPATION: CLINICS, REHABILITATION AGENCIES, AND PUBLIC HEALTH AGENCIES AS PROVIDERS OF OUTPATIENT PHYSICAL THERAPY AND/OR

SPEECH PATHOLOGY SERVICES

405.1701 Conditions of participation--general.

405.1702 Definitions relating to clinics, rehabilitation agencies, and public health agencies.

405.1715 Condition of participation-compliance with Federal, State, and local laws.

405.1716 Condition of participation-administrative management.

405.1717 Condition of participation-plan of care and physician involvement. 405.1718 Condition of participation-physical therapy services.

405.1719 Condition of participationspeech pathology services.

405.1720 Condition of participation-rehabilitation program. 405.1721 Condition of participation-ar

rangements for physical therapy and speech pathology services to be performed by other than salaried organization personnel.

405.1722 Condition of participation-clinical records.

405.1723 Condition of participation-physi

cal environment.

Introduction.

405.1801 405.1803 Intermediary determination and notice of amount of program reimbursement.

405.1804 Matters not subject to administrative or judicial review under prospective payment.

405.1805 Parties to intermediary determination.

405.1807 Effect of intermediary determination.

405.1809 Intermediary hearing procedures. 405.1811 Right to intermediary hearing; time, place, form, and content of request for intermediary hearing.

405.1813 Failure to timely request an intermediary hearing.

405.1815 Parties to the intermediary hearing.

405.1817 Hearing officer or panel of hearing officers authorized to conduct intermediary hearing; disqualification of officers.

405.1819 Conduct of intermediary hearing. 405.1821 Prehearing discovery and other proceedings prior to the intermediary hearing.

405.1823 Evidence at intermediary hearing. 405.1825 Witnesses at intermediary hearing.

405.1827 Record of intermediary hearing. 405.1829 Authority of hearing officer(s) at intermediary hearing.

405.1831 Intermediary hearing decision and notice.

405.2131 Condition: Provider status: Renal transplantation center or renal dialysis

center.

405.2132 [Reserved]

405.2133 Condition: Furnishing data and information for ESRD program administration.

405.2134 Condition: Participation in network activities.

405.2135 Condition: Compliance with Federal, State, and local laws and regulations.

405.2136 Condition: Governing body and

management.

405.2137 Condition: Patient long-term program and patient care plan.

405.2138 Condition: Patients' rights and re

sponsibilities.

405.2139 Condition: Medical records. 405.2140 Condition: Physical environment. 405.2150 Condition: Reuse of hemodialyzers and other dialysis supplies. 405.2160 Condition: Affiliation agreement or arrangement.

405.2161 Condition: Director of a renal dialysis facility or renal dialysis center. 405.2162 Condition: Staff of a renal dialysis facility or renal dialysis center. 405.2163 Condition: Minimal service requirements for a renal dialysis facility or renal dialysis center.

405.2164 Conditions for coverage of special purpose renal dialysis facilities.

405.2170 Condition: Director of a renal transplantation center.

405.2171 Condition: Minimal service requirements for a renal transplantation center.

405.2180 Termination of Medicare coverage.

405.2181 Alternative sanctions. 405.2182 Notice of sanction and appeal rights: Termination of coverage. 405.2184 Notice of appeal rights: Alternative sanctions.

Subparts V-W [Reserved]

Subpart X-Rural Health Clinic Services

405.2401 Scope and definitions. 405.2402 Basic requirements.

405.2403 Content and terms of the agreement with the Secretary.

405.2404 Terminations of agreements. 405.2410 Beneficiary entitlement and liability.

405.2411 Scope of benefits. 405.2412 Physicians' services.

405.2413 Services and supplies incident to a physician's services.

405.2414 Nurse practitioner and physician assistant services.

405.2415 Services and supplies incident to nurse practitioner and physician assistant services.