(Medicare General Information, Eligibility, and Entitlement)

 To post conspicuously information indicating whether or not the hospital or critical access hospital participates in the Medicaid program under a State plan approved under title XIX;   18. In the case of a hospital with an emergency department (including both the transferring and receiving hospitals), to maintain:    Medical and other records related to individuals transferred to or from the hospital for a period of 5 years from the date of the transfer;    A list of physicians who are on call for duty after the initial examination to provide treatment necessary to stabilize an individual with an emergency medical condition; and    A central log on each individual who comes to the emergency department seeking assistance and whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged.   19. Effective December 1, 1991, in the case of a hospital to comply with the advance directive provisions of 4206 of OBRA 1990.  Hospitals must, in accordance with written policies and procedures, for all adult individuals:    Inform them, in writing, of State laws regarding advance directives;    Inform them, in writing, of its policies regarding the implementation of advance directives (including a clear and concise explanation of a conscientious objection, to the extent that State law permits for a hospital or any agent of a hospital that, as a matter of conscience, cannot implement an advance directive);    Document in the individual's medical record whether the individual has executed an advance directive;    Not condition the provision of care or otherwise discriminate against an individual based on whether that individual has executed an advance directive (since the law does not require the individual to do so); and    Educate staff and the community on issues concerning advance directives.  20. Effective October 1, 2007, CMS revised the regulations governing provider agreements that require hospitals to disclose physician ownership information to patients when a referring physician (or his or her immediate family member) has an ownership interest in the hospital.  Pursuant to 42 CFR 489.20(u), hospitals must: (1) furni sh written notice to each patient at the beginning of the patients hospital stay or outpatient visit that the hospital is a physician- owned hospital, in order to assist the patient in making an informed decision regarding his or her care.  The notice must  disclose the fact that the hospital meets the Federal definition of a physician -owned hospital and that the list of physician owners or immediate family members of physicians is available upon request and must be provided to the patient at the time of the  request; and (2) require each physician who is a member of the hospitals medical staff to agree, as a condition of continued medical staff membership or admitting privileges, to disclose in writing to all patients the physician refers to the hospital any ownership or investment interest in the hospital held by the physician or held by an immediate family member of the physician.  Disclosure must be made at the time of the referral.   Effective October 1, 2008, hospitals that do not have any physician owners who refer patients to the hospital are exempt from the disclosure requirements (See 42 CFR 489.20(v)).  In addition, CMS may deny a provider agreement to a hospital that does not have procedures in place to notify patients of physician ownership in the hospital (See 42 CFR 489.12).  10.1.2 - Part A Deductible and Coinsurance  (Rev. 1, 09-11-02)  This section is a further explanation of 10.1.1 above.   The provider may charge the beneficiary or his or her representative:   The amount of the inpatient hospital deductible or, if less, the actual charges for the services;    The amount of inpatient hospital coinsurance applicable for each day the individual is furnished inpatient hospital services after the 60th day, during a benefit period;   The posthospital extended care coinsurance amount; and    In the case of durable medical equipment (DME) furnished as a home health service, 20 percent of the fee schedule amount.  10.1.3 - Part B Deductible and Coinsurance  (Rev. 1, 09-11-02)  This section is a further explanation of 10.1.1 above.   The provider may charge the beneficiary or other person on his or her behalf: the $100 deductible and 20 percent of the customary (insofar as reasonable) charges in excess of that deductible.  For hospital outpatient services, the allowable deductible charges depend on whether the hospital can determine the beneficiary's deductible status.  If the hospital is unable to determine the deductible status, it may charge the beneficiary its full custo mary charges up to $100.  If the beneficiary provides official information as to deductible status, the hospital may charge only the unmet portion of the deductible.  The hospital is required to indicate on the claim the amounts collected.  In the case of DME furnished as a home health service under Medicare Part B, the coinsurance is 20 percent of the fee schedule amount for the services, with the following exception:  If the DME is used, purchased by, or on behalf of the beneficiary at a pr ice at least 25 percent less than the reasonable charge for comparable new equipment, no coinsurance is required.  10.1.4 - Blood  (Rev. 18, Issued: 03-04- 05, Effective: 07 -01-05, Implementation: 07-05-05)   This section is a further explanation of 10.1.1.  A provider may charge the beneficiary (or other person on his or her behalf) only for the first three pints of blood or units of packed red cells furnished during the calendar year.  The charges may not exceed the provider's customary charges.  The provider may not charge for any whole blood or packed red cells in any of the following circumstances:   The provider obtained the blood or red cells at no charge other than a processing or service charge;    The blood or packed red cells have been replaced; or    The provider (or its blood supplier) receives from an individual, or a blood bank, a replacement offer.  This offer is applicable if the replacement blood would not endanger the health of a recipient and if the prospective donor's health would not be endan gered by making a blood donation.  In this case the provider is precluded from charging even if it or its blood supplier rejects the replacement offer.   Refer to Pub. 100-04, Medicare Claims Processing Manual, chapter 4, 231 regarding billing for blood and blood products under the Hospital Outpatient Prospective Payment System (OPPS).   10.1.5 - Services Requested by Beneficiary  (Rev. 1, 09-11-02)  This section is a further explanation of 10.1.1.  If services furnished at the request of a beneficiary (or his or her representative) are more expensive than, or in excess of, services covered under Medicare, a provider may charge the beneficiary an amount that does not exceed the difference between (1) the provider's customary charges for the services furnished; and (2) the provider's customary charges for the kinds and amounts of services that are covered under Medicare.  A provider may not charge for these services unless they have been requested by the beneficiary (or his or her representative) and may not require a beneficiary to request services as a condition of admission.  To avoid misunderstanding and disputes, a provider must inform any beneficiary who requests a service for which a charge will be made that there will be a specified charge for that service.   10.1.6 - Provider Charges to Beneficiary Where Provider Customarily Furnishes More Expensive Services Not Requested by Beneficiary  (Rev. 1, 09-11-02)  A provider that customarily furnishes an individual items or services that are more expensive than the items or services determined to be necessary in the efficient delivery of needed health services, may charge an individual entitled to benefits under Medicare for such more expensive items or services even though not requested by the individual.  The charge, however, may not exceed the amount by which the cost of (or, if less, the customary charges for) more expensive items or services furnished by such provider in the second cost reporting period immediately preceding the cost reporting period in which such charges are imposed, exceeds the applicable limit imposed under the provisions of 42 CFR 413.30.  This charge may be made only if:    The A/B MAC (A) or (HHH) determines that the charges have been calculated properly in accordance with the provisions of this regulation section;   The services are not emergency services as defined in 20.1 or 20.2  of this chapter;    The admitting physician has no direct or indirect financial interest in such provider;   CMS has provided notice to the public through notice in a newspaper of general circulation servicing the provider's locality and such other notice as the Secretary may require, of any charges the provider is authorized to impose on individuals entitled to benefits under Medicare on account of costs in excess of the costs determined to be necessary in the efficient delivery of needed health services under Medicare; and    The provider has identified such charges to such individual or person acting on his/her behalf as charges to meet the costs in excess of the costs determined to be necessary in the efficient delivery of needed health services under Medicare.  10.1.7 - Hospitals Participating in State Reimbursement Control Systems or Demonstration Projects  (Rev. 1, 09-11-02)  This section is a further explanation of 10.1.1.  A hospital receiving payment for a covered hospital stay under:   Either a State reimbursement control system approved under 1886 (c) of the Act; or    A demonstration project authorized under section 402(a) of Pub. L. 90 - 248 (42 U.S.C. 1395b - 1) or section 222(a) of Pub. L. 92 - 603 (42 U.S.C.1395b - 1 (NOTE)); and    Would otherwise be subject to the prospective payment system set forth in part 412 of this chapter, may also charge a beneficiary for custodial care and medically unnecessary services described in CFR CUR 412.42(c), after the conditions of 412.42(c)(1) through(c)(4) are met.  10.1.8 - Medicare Secondary Payer Involvement of Failure to File Proper Claims (Rev. 1, 09-11-02)  This section is a further explanation of 10.1.1.  A provider that has not filed a proper claim and has received a reduced payment because of this from a payer primary to Medicare agrees:   To bill Medicare for an amount no greater than would have been payable as secondary payment if the primary insurer's payment had been based on a proper claim; and    To charge the beneficiary only (a) the amount it would have been entitled to charge if it had filed a proper claim and received payment based on such a claim; and (b) an amount equal to any third-party payment reduction attributable to failure to file a proper claim, but only if the provider can show that:  o It failed to file a proper claim solely because the beneficiary, for any reason other than mental or physical incapacity, failed to give the provider the necessary information; or  o The beneficiary, who was responsible for filing a proper claim, failed to do so for any reason other than mental or physical incapacity.  10.1.9 - Advance Directive Requirements  (Rev. 1, 09-11-02)  Effective December 1, 1991, participating hospitals must comply with the advance directive provisions of 4206 of OBRA 1990.  Therefore, an agreement per 1866 of the Act with a hospital includes that the hospital must, in accordance with written policies and procedures, for all adult individuals: inform them, in writing, of state laws regarding advance directives; inform them, in writing, of its policies regarding the implementation of advance directives (including a clear and concise explanation of a conscientious objection, to the extent that state law permits for a hospital or any agent of a hospital that, as a matter of conscience, cannot implement an advance directive); document in the individual's medical record whether the individual has executed an advance directive; not condition the provision of care or otherwise discriminate against an individual based on whether that individual has executed an advance directive (since the law does not require the individual to do so); and educate staff and the community on issues concerning advance directives.   10.1.10 - Posting of Signs in Hospital Emergency Departments   Section 6018(a)(2) of the Omnibus Budget Reconciliation Act of 1989 (OBRA 89), effective July 1, 1990, requires hospitals with emergency departments to post signs which specify the rights (under section 1867 of the Social Security Act) of women in labor and individuals with emergency medical conditions to examination and treatment.  To comply with these requirements, hospitals must post signs that meet the following criteria:    At a minimum, the signs must specify the rights of unstable individuals with emergency conditions and women in labor who come to the emergency department for health care services;    It must indicate whether the facility participates in the Medicaid program;   The wording of the sign must be clear and in simple terms understandable by the population serviced;   Print the signs in English and other major languages that are common to the population of the area serviced;   The letters within the signs must be clearly readable at a distance of at least 20 feet or the expected vantage point of the emergency department patrons; and    Post signs in a place or places likely to be noticed by all individuals entering the emergency department, as well as those individuals waiting for examination and treatment (e.g., entrance, admitting area, waiting room, treatment area).