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 39
... reasonable charges . 405.508 Determination of comparable cir- cumstances ; limitation . 405.509 Determining the inflation - indexed charge . 405.511 Reasonable charges for medical services , supplies , and equipment . 405.512 Carriers ...
... reasonable charges . 405.508 Determination of comparable cir- cumstances ; limitation . 405.509 Determining the inflation - indexed charge . 405.511 Reasonable charges for medical services , supplies , and equipment . 405.512 Carriers ...
Page 40
... Reasonable charges for anesthesi- ology services . 405.554 Conditions for payment of charges : Radiology services ... Reasonable charges for physician laboratory services . 405.580 Conditions of payment for assist- ants at surgery in ...
... Reasonable charges for anesthesi- ology services . 405.554 Conditions for payment of charges : Radiology services ... Reasonable charges for physician laboratory services . 405.580 Conditions of payment for assist- ants at surgery in ...
Page 49
... reasonable cost and to any applicable deductible or coinsur- ance amounts . Example . A beneficiary received 60 days of inpatient hospital services for an injury that is compensable under workmen's com- pensation . This is the ...
... reasonable cost and to any applicable deductible or coinsur- ance amounts . Example . A beneficiary received 60 days of inpatient hospital services for an injury that is compensable under workmen's com- pensation . This is the ...
Page 50
... reasonable cost of furnishing semiprivate accommodations is $ 52 . X Hos- pital is entitled to receive $ 2 per day reim- bursement under Title XVIII ( the $ 52 per day reasonable cost of semiprivate accom- modations less the $ 50 per ...
... reasonable cost of furnishing semiprivate accommodations is $ 52 . X Hos- pital is entitled to receive $ 2 per day reim- bursement under Title XVIII ( the $ 52 per day reasonable cost of semiprivate accom- modations less the $ 50 per ...
Page 57
... reasonable charge basis . ( 1 ) Physician's charge for professional services .... ( 2 ) Employer plan's allowable charge ( 3 ) Medicare reasonable charge ( 4 ) As primary payer the employer plan pays 80 percent of allowable charge ...
... reasonable charge basis . ( 1 ) Physician's charge for professional services .... ( 2 ) Employer plan's allowable charge ( 3 ) Medicare reasonable charge ( 4 ) As primary payer the employer plan pays 80 percent of allowable charge ...
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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.