Model: atx-labs/gte-qwen-2.5-1.5B-ecfr_cms
Author: atx-labs
Pipeline: sentence-similarity
Library: sentence-transformers
Tags: sentence-transformers, safetensors, qwen2, sentence-similarity, feature-extraction, dense, generated_from_trainer, dataset_size:60906, loss:MultipleNegativesRankingLoss, custom_code, arxiv:1908.10084, arxiv:1705.00652, base_model:Alibaba-NLP/gte-Qwen2-1.5B-instruct, base_model:finetune:Alibaba-NLP/gte-Qwen2-1.5B-instruct, text-embeddings-inference, endpoints_compatible, region:us
Base models (finetune): id: Alibaba-NLP/gte-Qwen2-1.5B-instruct
Card metadata: tags: sentence-transformers, sentence-similarity, feature-extraction, dense, generated_from_trainer, dataset_size:60906, loss:MultipleNegativesRankingLoss
base_model: Alibaba-NLP/gte-Qwen2-1.5B-instruct
widget: source_sentence: No DRG payment is made on PPS bills that show "still patient" status The hospital may not split a bill for the periods before and after the onset of capital PPS that fall into the same billing period Capital payment issued for an inpatient hospital stay that begins prior to and ends after the onset of capital PPS is the amount determined by Pricer for that DRG No reasonable cost capital pass through payment is payable for the portion of the stay that pre-dates capital PPS.
sentences: Information for all enrollees of MCOs, PIHPs, PAHPs, and PCCM entities: (1) The MCO, PIHP, PAHP, and, when appropriate, the PCCM entity, must make a good faith effort to give written notice of termination of a contracted provider to each enrollee who received his or her primary care from, or was seen on a regular basis by, the terminated provider Notice to the enrollee must be provided by the later of 30 calendar days prior to the effective date of the termination, or 15 calendar days after receipt or issuance of the termination notice. (2) The State must notify all enrollees of their right to disenroll consistent with the requirements of § 438.56 at least annually, No DRG payment is made on PPS bills that show "still patient" status The hospital may not split a bill for the periods before and after the onset of capital PPS that fall into the same billing period Capital payment issued for an inpatient hospital stay that begins prior to and ends after the onset of capital PPS is the amount determined by Pricer for that DRG No reasonable cost capital pass through payment is payable for the portion of the stay that pre-dates capital PPS., wall of thorax without penetration into thoracic cavity, initial encounter S21.251A Open bite of right back wall of thorax without penetration into thoracic cavity, initial encounter S21.252A Open bite of left back wall of thorax without penetration into thoracic cavity, initial encounter, source_sentence: If a facility is certified as a hospital, a Medicare SNF, or any other facility that meets the requirements of §1861(e)(1) or §1819(a)(1) of the Act, it is not considered the patient's home Therefore, the institution's §1861(e)(1) or §1819(a)(1) status is used for these purposes also.
sentences: MACs shall report these PCC closures to the service reports mailbox within 1 hour of the decision to close the PCC if the decision to close was made during normal business hours, or by 9:00 a.m Eastern Time the next business day if the decision was made after business hours the night before or before business hours that day The email shall explain the reason for the PCC closure and, if known at the time, indicate when the PCC will reopen See section 80.2.3.6 of this chapter for the monthly PCID reporting requirements., If a facility is certified as a hospital, a Medicare SNF, or any other facility that meets the requirements of §1861(e)(1) or §1819(a)(1) of the Act, it is not considered the patient's home Therefore, the institution's §1861(e)(1) or §1819(a)(1) status is used for these purposes also., Implementation: 01-02-24) The transition to the standard Medicare coinsurance rate (20 percent of the APC payment rate) will be gradual For those APC groups for which coinsurance is currently a relatively high proportion of the total payment, the process will be correspondingly lengthy The law offers hospitals the option of electing to reduce coinsurance amounts and advertise their reduced rates for all OPPS services They may elect to receive a coinsurance payment from Medicare beneficiaries that is less than the wage adjusted coinsurance amount per APC That amount will apply to all services within that APC This coinsurance reduction must be offered to all Medicare beneficiaries, source_sentence: Compute the blend alternative Add the LTC-DRG per diem portion determined in step (1-c) and the IPPS comparable per diem portion determined in step (2-d) $6,671.84 + $4,491.10 $11,162.94 \* In this example, 25 days was used in the denominator since the 5/6th ALOS of LTC DRG XYZ (28.0 days) is greater than 25 days
sentences: An unsubstantiated complaint is an allegation where sufficient evidence could not be found to conclude that noncompliance with CLIA requirements existed during the investigation or at the time of the alleged violation A complaint may be received in either the SA or the RO The receiving organization should follow the procedures outlined below The SA obtains the following information for every complaint: · Complainant's name, address, and telephone number, unless the complainant requests anonymity; · Laboratory's name and address and · Description of problem, (e.g., personnel, places, and dates of occurrence)., Authorization of services. (b) For the processing of requests for initial and continuing authorizations of services, each contract must require— (1) That the MCO, PIHP, or PAHP and its subcontractors have in place, and follow, written policies and procedures. (2) That the MCO, PIHP, or PAHP— (i) Have in effect mechanisms to ensure consistent application of review criteria for authorization decisions. (ii) Consult with the requesting provider for medical services when appropriate. (iii) Authorize LTSS based on an enrollee's current needs assessment and consistent with the person-centered service plan. (3) That any decision to deny a service authorization request or, Compute the blend alternative Add the LTC-DRG per diem portion determined in step (1-c) and the IPPS comparable per diem portion determined in step (2-d) $6,671.84 + $4,491.10 $11,162.94 \* In this example, 25 days was used in the denominator since the 5/6th ALOS of LTC DRG XYZ (28.0 days) is greater than 25 days, source_sentence: However, if they provide a DMEPOS item that requires a licensed professional in order to properly provide the item, they shall provide a copy of the professional license The licensed professional may be licensed in any State or have a Federal license For example, a pharmacy does not need a pharmacy license, but shall have a licensed pharmacist on staff Site visits shall be conducted for all facilities of the IHS enrolling as IHS suppliers For enrollment purposes Medicare recognizes those facilities operated by the IHS and those facilities operated by the tribes The IHS enrollment shall be in accordance with the instructions provided for all DMEPOS suppliers on the Form CMS-855S, except for the following clarifications. · Facilities operated by the IHS, including pharmacies are considered a Federal government organization
sentences: The monthly billing file typically arrives in the state no later than the 1st business day of the month following the update If the file is not received by the 2nd business day of the month, the state must notify CMS CO staff within the Office of Financial Management (OFM)/Accounting Management Group (AMG)/Division of Premium Billing and Collections (DPBC) so that CMS may initiate another transmission of the state's billing files (see chapter 6, section 6.1.1.1 for contact information) The SAS and related documents are mailed separately and typically arrive in the state no later than the 20th of the month, However, if they provide a DMEPOS item that requires a licensed professional in order to properly provide the item, they shall provide a copy of the professional license The licensed professional may be licensed in any State or have a Federal license For example, a pharmacy does not need a pharmacy license, but shall have a licensed pharmacist on staff Site visits shall be conducted for all facilities of the IHS enrolling as IHS suppliers For enrollment purposes Medicare recognizes those facilities operated by the IHS and those facilities operated by the tribes The IHS enrollment shall be in accordance with the instructions provided for all DMEPOS suppliers on the Form CMS-855S, except for the following clarifications. · Facilities operated by the IHS, including pharmacies are considered a Federal government organization, The following messages are used by Medicare contractors when denying non-covered VNS services: MSN: 16.10 "Medicare does not pay for this item or service." CARC: 50 "These are non-covered services because this is not deemed a"medical necessity" by the payer." The following RARC messages can be used depending on liability: The patient has been relieved of liability of payment of these items and services under the limitation of liability provision of the law You, the provider, are ultimately liable for the patient's waived charges, including any charges for coinsurance, since the items or services were notreasonable and necessary or constituted custodial care, and you knew or could reasonably have been expected to know, that they were not covered, source_sentence: General supervision means that the physician need not be physically present at the patient's place of residence when the service is performed; however, the service must be performed under his or her overall supervision and control The physician orders the service(s) to be performed, and contact is maintained between the nurse or other employee and the physician, e.g., the employee contacts the physician directly if additional instructions are needed, and the physician must retain professional responsibility for the service All other "incident to" requirements must be met (see §§60-60.4). 3 The services are included in the physician's/clinic's bill, and the physician or clinic has incurred an expense for them (see §60.2). 4 The services of the paramedical are required for the patient's care; that is, they are reasonable and necessary as defined in the Medicare Benefit Policy Manual, Chapter 16, "General Exclusions from Coverage," §20. 5 When the service can be furnished by an HHA in the local area, it cannot be covered when furnished by a physician/clinic to a homebound patient under this provision, except as described in §60.4.C.
sentences: 110.2 - Inpatient Rehabilitation Facility Medical Necessity Criteria (Rev. 10892 Implementation: 11-08-21) In order for IRF care to be considered reasonable and necessary, the documentation in the patient's IRF medical record (which must include the preadmission screening described in section 110.1.1, the overall plan of care described in section 110.1.3, and the admission orders described in section 110.1.4) must demonstrate a reasonable expectation that the following criteria were met at the time of admission to the IRF Certain exceptions to these requirements may apply due to conditions arising during the Public Health Emergency defined in 42 CFR § 400.200 These exceptions are described further in Section 110.2.6 of this manual. 1\, Implementation: 11-01-24) Transmit the CMS-2591 to CO via PC or terminal Use instructions in the CROWD User Guide available via the CMS Enterprise Portal The report is due as soon as possible after the end of the reporting month but no later than the 15th of the month following the end of the reporting month., General supervision means that the physician need not be physically present at the patient's place of residence when the service is performed; however, the service must be performed under his or her overall supervision and control The physician orders the service(s) to be performed, and contact is maintained between the nurse or other employee and the physician, e.g., the employee contacts the physician directly if additional instructions are needed, and the physician must retain professional responsibility for the service All other "incident to" requirements must be met (see §§60-60.4). 3 The services are included in the physician's/clinic's bill, and the physician or clinic has incurred an expense for them (see §60.2). 4 The services of the paramedical are required for the patient's care; that is, they are reasonable and necessary as defined in the Medicare Benefit Policy Manual, Chapter 16, "General Exclusions from Coverage," §20. 5 When the service can be furnished by an HHA in the local area, it cannot be covered when furnished by a physician/clinic to a homebound patient under this provision, except as described in §60.4.C.
pipeline_tag: sentence-similarity
library_name: sentence-transformers
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Created: 2025-12-12 16:35:40