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
... initial complaint but there is need for fur- ther investigation . ( 2 ) The name and address of any provider of medical services , organiza- tion , or other person found , after con- sultation with an appropriate profes- sional ...
... initial complaint but there is need for fur- ther investigation . ( 2 ) The name and address of any provider of medical services , organiza- tion , or other person found , after con- sultation with an appropriate profes- sional ...
Page 15
... not been exhausted on the initial determination . The decision will in- clude the basis for it and will advise the requester of his right to judicial review . ( 15 Health Care Financing Administration , HHS § 401.148.
... not been exhausted on the initial determination . The decision will in- clude the basis for it and will advise the requester of his right to judicial review . ( 15 Health Care Financing Administration , HHS § 401.148.
Page 19
... initial determination for purposes of HCFA appeal procedures . PART 402- [ RESERVED ] PART 403 - SPECIAL PROGRAMS AND PROJECTS Subpart A- [ Reserved ] Subpart B - Medicare Supplemental Policies Sec . 403.200 Basis and scope . GENERAL ...
... initial determination for purposes of HCFA appeal procedures . PART 402- [ RESERVED ] PART 403 - SPECIAL PROGRAMS AND PROJECTS Subpart A- [ Reserved ] Subpart B - Medicare Supplemental Policies Sec . 403.200 Basis and scope . GENERAL ...
Page 24
... Initial calculation date " means the first date of the period that the in- suring organization uses to calculate the policy's expected loss ratio . ( 1 ) The initial calculation date may be before , the same as , or after the date the ...
... Initial calculation date " means the first date of the period that the in- suring organization uses to calculate the policy's expected loss ratio . ( 1 ) The initial calculation date may be before , the same as , or after the date the ...
Page 25
... initial calculation date of- ( A ) Expected incurred benefits in the loss ratio calculation period , to- ( B ) The total policy reserve at the last day of the loss ratio calculation period : and ( ii ) Subtracting the total policy re ...
... initial calculation date of- ( A ) Expected incurred benefits in the loss ratio calculation period , to- ( B ) The total policy reserve at the last day of the loss ratio calculation period : and ( ii ) Subtracting the total policy re ...
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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...