Sec. 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. 405.541 Criteria for determination of reasonable charges for nonprovider renal dialysis facility services. 405.542 Criteria for determination of reasonable charges for physicians' services rendered to renal dialysis patients. 405.543 Criteria for determination of reasonable charges for physicians renal transplantation services. 405.544 Payment for durable medical equipment and supplies for home dialysis. Subpart F-Notice, Election and Agreements 405.640 Notice of determination by the Secretary rescinding approval of coverage of services of independent laboratory or supplier of portable X-ray services. 405.658 Emergency hospital services; hospital election to receive health insurance payments. 405.659 Reinstatement of emergency serv ice hospital after notice of failure to continue to comply. 405.685 Agreements with States pursuant to section 1864; general. 405.690 Agreements with ESRD facilities for reimbursement of home dialysis equipment without regard to deductibles and coinsurance. 405.691 Agreements with approved providers or ESRD facilities for reimbursement of home dialysis supplies, equipment, and support services on a target reimbursement rate basis. Sec. 405.831 Waiver of right to appear and present evidence. 405.832 Dismissal of request for hearing. 405.833 Record of hearing. 405.834 Hearing officer's decision. 405.835 Effect of hearing officer's decision. 405.841 Reopening initial or review determination of the carrier, and decision of a hearing officer. 405.842 Notice of reopening and revision. 405.850 Change of ruling or legal precedent. 405.860 Authority of the hearing officer. 405.870 Appointment of representative. 405.871 Qualifications of representatives. 405.872 Authority of representatives. Subpart I-Premiums for Supplementary Medical Insurance Benefits 405.901 Scope of subpart. 405.902 Amount of premiums. 405.903 Months for which premiums are due; payment obligation. 405.904 Payment of premiums; general. 405.906 Premiums not required for certain kidney donors. 405.908 Payment by direct remittance; rules governing payment. while 405.911 Collection from enrollees in monthly benefit payment status. 405.912 Collection of premiums monthly benefits are suspended. 405.913 Collection of overdue premiums for months in a closed taxable year. 405.914 Payment within the grace period. 405.915 Possible entitlement to social security or railroad retirement benefits. 405.916 Effect of entitlement to age-72 special payment. 405.920 Premium payment: Individual not entitled to monthly benefits and not enrolled pursuant to Federal-State agreement. 405.921 Payment of premium on monthly or 3-month basis. 405.927 Due date and grace period. 405.928 Extension where last day of grace period is a nonworkday. 405.929 Extension of grace period for good cause. 405.936 Enrollee changes from 3-month to monthly premium payment basis after coverage begins. 405.940 Group collection; general. 405.941 Rules governing payment of premiums due from a group of enrollees; single notice arrangement. 405.942 Payment by groups. 405.946 Quarterly billing; group payment plan. 405.947 Enrollee dropped from group payment plan. 405.948 Responsibilities of parties to group collection arrangements. 405.949 Termination of group billing. Subpart J-Conditions of Participation; 405.1011 Provision of emergency services 405.1022 Condition of participation-Physical environment. 405.1023 Condition of participation-Medical staff. 405.1024 Condition of participation-Nursing department. 405.1025 Condition of participation-Dietary department. 405.1026 Condition of participation-Medical record department. 405.1027 Condition of participation-Pharmacy or drug room. 405.1028 Condition of participation-Laboratories. 405.1029 Condition of participation-Radiology department. 405.1030 Condition of participation-Medical library. 405.1031 Condition of participation-Com plementary departments. 405.1032 Condition of participation-Outpatient department. 405.1033 Condition of participation-Emergency service or department. 405.1034 Condition of participation-Social work department. 405.1035 Condition of participation-Utilization review plan. 405.1036 Special rules and exceptions applying to psychiatric and tuberculosis hospitals. 405.1037 Condition of participation-Spe cial medical record requirements for psychiatric hospitals. 405.1038 Condition of participation-Spe cial staff requirements for psychiatric hospitals. 405.1039 Condition of participation-Spe cial medical record requirements for tuberculosis hospitals. 405.1040 Condition of participation-Special staff requirements for tuberculosis hospitals. 405.1120 Condition of participation-compliance with Federal, State, and local laws. 405.1121 Conditions of participation-governing body and management. 405.1122 Condition of participation-medical direction. 405.1123 Condition of participation-physician services. 405.1124 Condition of participation-nursing services. 405.1125 Condition of participation-dietetic services. 405.1126 Condition of participation-specialized rehabilitative services. 405.1127 Condition of participation-pharmaceutical services. 405.1128 Condition of participation-laboratory and radiologic services. 405.1129 Condition of participation-dental services. 405.1130 Condition of participation-social services. Sec. 405.1505 Administrative actions which ar not initial determinations. 405.1510 Reconsideration: Right to recon sideration. 405.1511 Time and place of filing reques for reconsideration. 405.1512 Proper party for filing request fo reconsideration. 405.1513 Withdrawal of request for recon sideration. 405.1514 Reconsidered determination. 405.1515 Submission of evidence. 405.1516 Notice of reconsidered determina tion. 405.1517 Effect of reconsidered determina tion. 405.1518 Extension of time to request re consideration. 405.1519 Revision of initial or reconsidere determinations. 405.1520 Notice of revision. 405.1521 Effect of revised determination. 405.1530 Hearing: Right to hearing. 405.1531 Filing a request for a hearing time and manner of filing. 405.1532 Parties to the hearing. 405.1533 Administrative Law Judge. 405.1534 Disqualification of Administrativ Law Judge. 405.1535 Prehearing conference. 405.1536 Time and place of prehearing con ference. 405.1537 Conduct of prehearing confer ence. 405.1538 Record of prehearing conference 405.1539 Effect of prehearing conference. 405.1540 Time and place of hearing. 405.1541 Change of time and place fo hearing. 405.1542 Hearing on new issues. 405.1543 Joint hearings. 405.1544 Subpoenas. 405.1545 Conduct of the hearing. 405.1546 Evidence. Sec. 405.1561 Right to request a review of Administrative Law Judge's decision or dismissal. 405.1562 Time and place of filing requests for review. 405.1563 Action by the Appeals Council on request for review. 405.1564 Procedures before the Appeals Council on review. 405.1565 Evidence admissible on review. 405.1566 Decision of the Appeals Council or remanding of case. 405.1567 Effect of the Appeals Council decision. 405.1568 Dismissal by Appeals Council. 405.1569 Extension of time to request a hearing or review or begin civil action. 405.1570 Reopening decisions of an Administrative Law Judge or the Appeals Council. 405.1571 Notice of revision. Subpart P-Certification and Recertification; Claims and Benefit Payment Requirements; Check Replacement Procedures 405.1625 Certification and recertification by physicians; general. 405.1625-1 Certification and recertification by physicians: applicability of requirements when Professional Standards Review Organizations perform review. 405.1627 Inpatient hospital services other than inpatient psychiatric or tuberculosis hospital services; certification and recertification for services furnished on or after January 3, 1968. 405.1629 Inpatient tuberculosis hospital services and inpatient psychiatric hospital services; certification and recertification. 405.1630 Certification and recertification for beneficiary admitted to a hospital before entitlement to benefits. 405.1632 Post-hospital extended care services; certification and recertification. 405.1633 Home health services; certification and recertification. 405.1634 Medical and other health services covered by the supplementary medical insurance program furnished by a provider of services; certification and recertification. 405.1660 Payment on behalf of the individual; general. 405.1662 Form used for claiming payment. 405.1663 Individual's request for payment. Sec. 405.1664 Persons authorized to request payment. 405.1665 Evidence of authority to execute a request for payment. 405.1666 Signature by representative of the participating provider or hospital. 405.1667 Claim for payment by a provider of services or a hospital which has elected to claim payment for emergency services or services outside the United States. 405.1668 Prohibition of assignment of benefits by a provider. 405.1672 Individual's request for direct payment-General provisions. 405.1674 Individual's request for direct payment; evidence describing services. 405.1675 Assignment of right to receive payment under the supplementary medical insurance benefits plan. 405.1678 Direct payment or assignment of payment; prescribed form. 405.1679 Execution of claim for payment. 405.1680 Limitation on reassignment of benefits. 405.1681 Revocation of right to receive assigned benefits. 405.1682 Conditions court-ordered assign ments and reassignments must meet to be excepted from basic prohibition. 405.1683 Payment on the basis of a paid bill; individual dies before receiving direct payment. 405.1684 Payment on the basis of an unpaid bill; individual dies before receiving direct payment or assigning payment. 405.1685 Payment to organizations that pay bills on behalf of enrollees. 405.1686 Organizations qualified to receive payment on behalf of enrollee 405.1692 Time limitation for claiming benefits payable on a reasonable charge basis. 405.1693 Definition of claim for purposes of time limitation. 405.1694 Extension of time limitation. 405.1695 Replacement of U.S. Government checks that are lost, stolen, defaced, mutilated, destroyed, or paid on forged endorsements. 405.1696 Replacement of intermediary and carrier checks that are lost, stolen, defaced, mutilated, destroyed, or paid on forged endorsements. 405.1697 Reclamation proceedings in cases of forgery of intermediary and carrier checks. |