Code of Federal Regulations: Containing a Codification of Documents of General Applicability and Future Effect as of December 31, 1948, with Ancillaries and IndexDivision of the Federal Register, the National Archives, 1988 Special edition of the Federal Register, containing a codification of documents of general applicability and future effect ... with ancillaries. |
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Page 5
... Services ( HHS ) , formerly the Department of Health , Education , and ... Services . " HHA " stands for home health agency . " HMO " stands for health mainte ... items furnished or pro- posed to be furnished to Medicare beneficiaries ...
... Services ( HHS ) , formerly the Department of Health , Education , and ... Services . " HHA " stands for home health agency . " HMO " stands for health mainte ... items furnished or pro- posed to be furnished to Medicare beneficiaries ...
Page 6
... services that are covered under Part A of title XVIII of the Act . Intermediary " means an entity that has a ... items , such as medical di- agnosis and treatment , drugs and bio- logicals , supplies , appliances , and equipment , medical ...
... services that are covered under Part A of title XVIII of the Act . Intermediary " means an entity that has a ... items , such as medical di- agnosis and treatment , drugs and bio- logicals , supplies , appliances , and equipment , medical ...
Page 11
... items from the files , and records will not be created to pro- vide the ... Services ( 45 CFR Part 5 ) and the ap- pendix to that regulation . ( b ) ... services shall not identify individual patients , individual health care practi ...
... items from the files , and records will not be created to pro- vide the ... Services ( 45 CFR Part 5 ) and the ap- pendix to that regulation . ( b ) ... services shall not identify individual patients , individual health care practi ...
Page 22
... services and items that are not reimbursed under the Medicare program because of deducti- bles , coinsurance , or other limitations under Medicare . ( b ) Unless otherwise specified in this subpart , the term " policy " includes both ...
... services and items that are not reimbursed under the Medicare program because of deducti- bles , coinsurance , or other limitations under Medicare . ( b ) Unless otherwise specified in this subpart , the term " policy " includes both ...
Page 30
... items and services had the State system not been in effect . States must submit the as- surance and supporting data as re- quired by § 403.320 to document that the payment limit is not exceeded . States that have an existing Medicare ...
... items and services had the State system not been in effect . States must submit the as- surance and supporting data as re- quired by § 403.320 to document that the payment limit is not exceeded . States that have an existing Medicare ...
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Common terms and phrases
adjusted administrative agreement allowable cost amended amount amount in controversy ance applicable appropriate approved assets basis carrier chapter clinic cluding coinsurance contract period cost reporting period coverage covered services deductible deter dialysis doctor of medicine durable medical equipment effective eligible entitled equipment ESRD facility Federal filed HCFA health maintenance organization health services HMO's home health hospice care hospital's ices incurred individual initial determination intermediary items or services laboratory limits Medi Medicaid Medicare enrollees meet ment month nished notice organiza organization outpatient party patient payment rates percent physi physical therapy physician premiums procedures prospective payment provider's Public Health qualified reasonable charge reasonable cost records Redesignated at 42 reim reimbursement renal renal dialysis request requirements Secretary Sept serv services furnished Social Security Act specified in paragraph speech pathology Standard Subpart termination tient tion treatment
Popular passages
Page 54 - Notwithstanding any other provision 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 57 - UNDER WORKERS' COMPENSATION §405.316 Nonreimbursable expenses; payment for services made under workmen's compensation law. (a) Payment may not be made under Title 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 342 - The objective is that under the methods of determining costs, the costs with respect to individuals covered by the program will not be borne by individuals not so covered, and the costs with respect to individuals not so covered will not be borne by the program.
Page 153 - Maintains clinical records on all patients; (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 137 - ... (2) has policies, which are developed with the advice of (and with provision of review of such policies from time to time by) a group of professional personnel, including one or more physicians and one or more registered professional nurses, to govern the skilled nursing care and related medical or other services it provides; (3) has a physician, a registered professional nurse, or a medical staff responsible for the execution of such policies; (4) (A...
Page 275 - ... (1) part-time or intermittent nursing care provided by or under the supervision of a registered professional nurse...
Page 74 - No certifying or disbursing officer shall be held liable for any amount certified or paid by him to any person where the adjustment or recovery of such amount is waived under subsection (b), or where adjustment under subsection (a) is not completed prior to the death of all persons against whose benefits deductions are authorized.
Page 89 - 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 162 - A baccalaureate degree program approved by the National League for Nursing for public health nursing preparation or postbaccalaureate study which includes content approved by the National League for Nursing for public health nursing preparation; and 30-1&I O-79 20 (2) Three years of experience in public health nursing under qualified nursing supervision.
Page 130 - A representative shall be entitled to present or elicit evidence and allegations as to facts and law in any proceeding affecting the party he represents and to obtain information with respect to the claim of such party to the same extent as such party. Notice to any party of any administrative action, determination, or decision, or request to any party for the production of evidence may be sent to the representative of such party, and such notice or request shall have the same force and effect as...