The Code of Federal Regulations of the United States of AmericaU.S. Government Printing Office, 1985 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 15
... basis at actual cost . ( 3 ) Certification or authentication of records . Three dollars per certifica- tion or authentication . ( 4 ) Forwarding materials to destina- tion . Any special arrangements for forwarding which are requested ...
... basis at actual cost . ( 3 ) Certification or authentication of records . Three dollars per certifica- tion or authentication . ( 4 ) Forwarding materials to destina- tion . Any special arrangements for forwarding which are requested ...
Page 35
... basis of a paid bill ; individual dies before receiving direct payment . 405.1684 Payment on the basis of an unpaid bill ; individual dies before receiv- ing direct payment or assigning pay- ment . 405.1685 Payment to organizations that ...
... basis of a paid bill ; individual dies before receiving direct payment . 405.1684 Payment on the basis of an unpaid bill ; individual dies before receiv- ing direct payment or assigning pay- ment . 405.1685 Payment to organizations that ...
Page 86
... basis . The Medicare sec- ondary payment will be the lowest of the following : ( 1 ) The actual charge by the suppli- er , minus the amount paid by the em- ployer plan . ( 2 ) The amount that Medicare would pay if the services were not ...
... basis . The Medicare sec- ondary payment will be the lowest of the following : ( 1 ) The actual charge by the suppli- er , minus the amount paid by the em- ployer plan . ( 2 ) The amount that Medicare would pay if the services were not ...
Page 90
... basis of the employed individual's social se- curity record or the spouse's own social security record . ( b ) Medicare will pay primary bene- fits for Medicare covered services , if an individual is not covered under an em- ployer ...
... basis of the employed individual's social se- curity record or the spouse's own social security record . ( b ) Medicare will pay primary bene- fits for Medicare covered services , if an individual is not covered under an em- ployer ...
Page 100
... basis under Part 412 of this chapter . Pay- ment to these hospitals for capital - re- lated costs ( as described in § 405.414 ) and direct medical education costs ( as described in § 405.421 , with the excep- tion of those costs ...
... basis under Part 412 of this chapter . Pay- ment to these hospitals for capital - re- lated costs ( as described in § 405.414 ) and direct medical education costs ( as described in § 405.421 , with the excep- tion of those costs ...
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Common terms and phrases
adjusted Administration agreement allowable cost amended amount amount in controversy ance applicable appropriate approved assets basis benefits carrier certification clinic coinsurance contract period cost reporting period coverage covered services deductible dialysis eligible end-stage renal disease enrollment entitled equipment Federal filed HCFA Health Care Financing health insurance health insurance program health services HMO's hospice care hospital's ices incurred individual initial determination intermediary items and services items or services laboratory Medi Medicaid Medicare enrollees meet ment month nished notice organiza organization outpatient party patient personnel physi physical therapy physician policies premiums procedures prospective payment provider of services provider's qualified reasonable charge reasonable cost Redesignated at 42 reim reimbursement renal renal dialysis request requirements Secretary Sept services furnished Social Security Act Social Security Administration specified in paragraph speech pathology Subpart supplementary medical insurance supplier surgical termination tient tion treatment utilization review
Popular passages
Page 71 - 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 76 - 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 203 - USE OF STATE AGENCIES TO DETERMINE COMPLIANCE BY PROVIDERS OF ' SERVICES WITH CONDITIONS OF PARTICIPATION "SEC. 1864. (a) The Secretary shall make an agreement with any State which is able and willing to do so under which the services of the State health agency or other appropriate State agency (or the appropriate local agencies) will be utilized by...
Page 236 - 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.
Page 370 - ... (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 231 - Being known to the plaintiff, it is to be presumed, in the absence of any evidence to the contrary, that the parties contracted in reference to it.
Page 211 - ... 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 447 - States or (B) an alien lawfully admitted for permanent residence who has resided in the United States (as...
Page 143 - ... will not be borne by individuals not so covered, and the costs with respect to individuals not so covered will not be borne by such insurance programs...
Page 190 - Paragraph (4) shall not apply to services provided in the hospital by 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...