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 13
... charged with the administration of a program receiving grants - in - aid under title V and XIX of the Social Security ... charges made by physicians , other practition- ers , or suppliers , and amounts paid under Medicare for services ...
... charged with the administration of a program receiving grants - in - aid under title V and XIX of the Social Security ... charges made by physicians , other practition- ers , or suppliers , and amounts paid under Medicare for services ...
Page 14
... charges . ( a ) Statement of policy . It is HCFA's policy to comply with certain requests for information services without charge . Except as otherwise deter- mined pursuant to paragraph ( c ) of this section , fees will be charged for ...
... charges . ( a ) Statement of policy . It is HCFA's policy to comply with certain requests for information services without charge . Except as otherwise deter- mined pursuant to paragraph ( c ) of this section , fees will be charged for ...
Page 28
... charges to benefici- aries . Sec . 405.310 Particular services excluded from coverage . 405.310-1 Nonreimbursable expenses ; con- clusive effect of PSRO determinations on claims payment . 405.311 GENERAL EXCLUSIONS Nonreimbursable ...
... charges to benefici- aries . Sec . 405.310 Particular services excluded from coverage . 405.310-1 Nonreimbursable expenses ; con- clusive effect of PSRO determinations on claims payment . 405.311 GENERAL EXCLUSIONS Nonreimbursable ...
Page 30
... Charges ; Reimbursement for Serv- ices of Hospital Interns , Residents , and Su- pervising Physicians 405.501 Determination charges . of reasonable 405.502 Criteria for determining reasona- ble charges . 405.503 Determining customary ...
... Charges ; Reimbursement for Serv- ices of Hospital Interns , Residents , and Su- pervising Physicians 405.501 Determination charges . of reasonable 405.502 Criteria for determining reasona- ble charges . 405.503 Determining customary ...
Page 39
... charges for routine and ancillary serv- ices , 60 percent of the hospital's rea- sonable charges for routine services furnished in the accommodations oc- cupied by the Medicare beneficiary or in semiprivate accommodations , whichever is ...
... charges for routine and ancillary serv- ices , 60 percent of the hospital's rea- sonable charges for routine services furnished in the accommodations oc- cupied by the Medicare beneficiary or in semiprivate accommodations , whichever is ...
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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...