The Code of Federal Regulations of the United States of AmericaU.S. Government Printing Office, 1989 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 30
... payment rates . The system , if it is prospective may not permit providers to file ad- ministrative appeals that would result in a retroactive revision of prospective- ly determined payment rates . ( c ) Satisfactory assurances . The ...
... payment rates . The system , if it is prospective may not permit providers to file ad- ministrative appeals that would result in a retroactive revision of prospective- ly determined payment rates . ( c ) Satisfactory assurances . The ...
Page 31
... payments would be capped automatically at payment levels based on the rates used for the Medicare prospective payment system and the State would be required to pay the difference to individual hospi- tals in its system ; or ( B ) The ...
... payments would be capped automatically at payment levels based on the rates used for the Medicare prospective payment system and the State would be required to pay the difference to individual hospi- tals in its system ; or ( B ) The ...
Page 32
... pay- ment would have been under the Med- icare payment system . Recoupments may be accomplished by a hospital's direct payment to the Medicare pro- gram or by offsets to future payments made to the hospital . ( c ) Alternative ...
... pay- ment would have been under the Med- icare payment system . Recoupments may be accomplished by a hospital's direct payment to the Medicare pro- gram or by offsets to future payments made to the hospital . ( c ) Alternative ...
Page 38
... payment . GENERAL EXCLUSIONS 405.311 Nonreimbursable expenses ; individ- ual has no legal obligation to pay for items or services . 405.311a Nonreimbursable expenses ; items or services funished by a Federal provid- er of services or ...
... payment . GENERAL EXCLUSIONS 405.311 Nonreimbursable expenses ; individ- ual has no legal obligation to pay for items or services . 405.311a Nonreimbursable expenses ; items or services funished by a Federal provid- er of services or ...
Page 39
... payment . 405.343 Limitation on right of provider to charge a beneficary . 405.344 Conditional payment and recovery of payments . LIABILITY FOR PAYMENTS TO PROVIDERS OR SUPPLIERS AND HANDLING OF INCORRECT PAYMENTS 405.350 Individual's ...
... payment . 405.343 Limitation on right of provider to charge a beneficary . 405.344 Conditional payment and recovery of payments . LIABILITY FOR PAYMENTS TO PROVIDERS OR SUPPLIERS AND HANDLING OF INCORRECT PAYMENTS 405.350 Individual's ...
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Common terms and phrases
adjustment administrative agency agreement allowable cost amended amount amount in controversy applicable appropriate approved assets basis benefits carrier chapter clinic cluding coinsurance contract period cost reporting period coverage covered services deductible deter dialysis durable medical equipment eligible employees enrollment period entitled ESRD facility Federal filed HCFA health maintenance organization health services HMO's hospice care hospital's ices incurred individual initial determination interim intermediary items or services laboratory limits Medi Medicaid Medicare enrollees meet ment month nished notice nursing organiza organization outpatient paid party patient payment rates percent physi physical therapy physician premiums procedures prospective payment prospective payment system provider's qualified reasonable charge reasonable cost records Redesignated at 42 reim reimbursement renal renal dialysis reporting periods beginning request requirements Secretary Sept services furnished Social Security Act specified in paragraph speech pathology Standard Subpart supplier termination tient tion
Popular passages
Page 292 - 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 50 - 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 488 - Secretary determines to be reasonable, taking into account the range of interest rates prevailing in the private market for similar loans and the risks assumed by the United States...
Page 266 - ... (1) part-time or intermittent nursing care provided by or under the supervision of a registered professional nurse...
Page 207 - ... (2) there will be interchange of medical and other information necessary or useful in the care and treatment of individuals transferred between the institutions, or in determining whether such individuals can be adequately cared for otherwise than in either of such institutions.
Page 127 - 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 353 - 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 642 - ... a plan for furnishing^ such services to such individual has been established and is periodically reviewed by a physician; and such services are or were • furnished while the individual was under the care of a physician...
Page 557 - SEC. 207. (a) Section 201 of this title shall take effect on the first day of the first month following the month in which it is enacted.
Page 46 - ... (c) Eye examinations for the purpose of prescribing, fitting, or changing eyeglasses or contact lenses for refractive error only and procedures performed in the course of any eye examination to determine the refractive state of the eyes, without regard to the reason for the performance of the refractive procedures.