(Medicare Claims Processing Manual Crosswalk)

Medicare Claims Processing Manual Chapter 30 - Financial Liability Protections  New Chap. New Sect. Int.  Pub. 13 Carrier Pub. 14 PMs                        Other Description30 10 Financial Liability Protections (FLP) Provisions of Title XVIII  30 20 A3-3431 B3-7300.1 Limitation On Liability (LOL) Under 1879 Where Medicare Claims Are Disallowed 30 20.1 - 20.1.3  B3-7300.2, B3-7300.3 CMS Rulings:  Coverage Denials to Which the Limitation on Liability Applies     95-1,    96-2,    96-3,    97-1 30 20.2 - 20.2.2   PM AB-02-168     Part I  CMS Ruling 95-1,  Denials for Which the Limitation On Liability Provision Does Not Apply 30 30 A3-3432 B3-7300.4 Determining Liability for Disallowed Claims Under 1879 30 30.1 - 30.1.2 A3-3432.1  PM AB-02-168  Determining Beneficiarys Liability  30 30.2 - 30.2.3 A3-3432.2   CMS Ruling 95-1 Determining Provider, Practitioner, or Supplier Liability  New Chap. New Sect. Int.  Pub. 13 Carrier Pub. 14 PMs Other Description 30                      40 A3-3432.1 PM AB-02-168  CMS Ruling 95-1 Determining Knowledge for FLP Purposes  30 40.1 - 40.1.4 A3-3439, A3-3440   CMS Ruling 95-1 Determining Whether Provider, Practitioner, or Supplier Had Knowledge of Noncoverage of Services  30 40.2 - 40.2.4 A3-3439.1 B3-7300.5  CMS Ruling 95-1 Determining Whether Beneficiary Had Knowledge of Noncoverage of Services 30 40.3 - 40.3.8   PM AB-02-168  Advance Beneficiary Notice Standards  30 50 - 50.1.4    PM AB-02-168 Part I Form CMS-R-131 Advance Beneficiary Notice (ABN)  30 50.2 - 50.2.6     When and to Whom an ABN Should Be Given  30 50.3 - 50.3.5     Delivery of the ABN  30 50.4 Choosing the ABN Form to Use  30 50.5 Form Instructions for ABN-G and ABN-L (Form CMS-R-131)  30 50.6 Signature Requirements  30 50.7 - 50.7.7     Special Rules  30 50.8 - 50.8.3   PM AB-02-168, Part III  Instructions for Fiscal Intermediaries and Providers on Advance Beneficiary Notice (ABN) Standards for Items and Services for Which Institutional Part B Claims Will Be Processed by Fiscal Intermediaries and on Limits on Beneficiary Liability for Medical Equipment and Supplies New Chap. New Sect. Int.  Pub. 13 Carrier Pub. 14 PMs Other Description 30 50.9 - 50.9.3   PM AB-02-168, Part IV   Instructions for Regional Home Health Intermediaries (RHHIs) and Hospices on Advance Beneficiary Notice (ABN) Standards for Certain Hospice Claims 30                60 PM A-03-024,  PM A-03-025   Form CMS-R-296 Home Health Advance Beneficiary Notice (HHABN) 30 60.1 - 60.1.4     Basic Requirements for HHABNs  30 60.2 - 60.2.5     When and to Whom an HHABN Should Be Given  30 60.3 - 60.3.5     Delivery of HHABNs  30 60.4 - 60.4.4     Form Instructions for the HHABN (Form CMS-R-296) 30 60.5 Signature Requirements for HHABN  30 60.6 - 60.6.9.4     Special Rules for HHABNs  30 70 - 70.1.3 A3-3730.1    Form CMS-10055 Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) 30 70.2 - 70.2.5     When and to Whom a SNFABN Should Be Given  30 70.3 - 70.3.5     Delivery of SNFABNs (Section heading only)  30 70.4 - 70.4.5     Form Instructions for the SNFABN (Form CMS-10055)  30 70.5 Signature Requirements for SNFABN  30 70.6 - 70.6.9.4     Special Rules for SNFABNs (Section heading only) New Chap. New Sect. Int.  Pub. 13 Carrier Pub. 14 PMs Other Description 30                                               80 Hospital ABNs (Hospital-Issued Notices of Noncoverage - HINN) 30 80.1 - 80.1.6     When and to Whom a Hospital ABN Should Be Given 30 80.2 Issuing the Appropriate Hospital ABN 30 80.3 - 80.3.6     Hospital ABNs (HINNs) 30 80.4 - 80.4.3     Signature Requirements 30 80.5 QIO Review Authority for Hospital ABNs 30 80.6 - 80.6.2     QIO Monitoring of Hospital ABNs 30 80.7 Notices in Investigational/Experimental Procedures Situations 30 80.8 - 80.8.4     Beneficiary Liability 30 80.9 Provider Liability 30 80.10 - 80.10.1     Right to a Reconsideration 30 90 - 90.5     Form CMS-20007 - Notices of Exclusions From Medicare Benefits (NEMBs) 30 100 A3-3446 B3-7320 Indemnification Procedures for Claims Falling Within the Limitation on Liability Provision 30 100.1 A3-3446.1 B3-7320.1 Contractor and Social Security Office (SSO) Responsibility in Indemnification Claims 30 100.2 A3-3446.2 B3-7320.23,B3-7300.5 Conditions for Indemnification New Chap. New Sect. Int.  Pub. 13 Carrier Pub. 14 PMs Other Description 30                                                                                   100.3 A3-3446.3 B3-7320.3 Development and Documentation of Indemnification Requests 30 100.4 A3-3446.4 B3-7320.4 Beneficiary Requests Indemnification, but Had No Financial Interest in the Claim 30 100.5 A3-3446.5 B3-7320.5 Questionable Indemnification Requests Procedure 30 100.6 A3-3446.6 B3-7320.6 Determining the Amount of Indemnification 30 100.7 A3-3446.7 B3-7320.7 Notifying the Provider, Practitioner, or Supplier 30 100.8 A3-3446.8 B3-7320.8 Making Payment Under Indemnification 30 100.9 B3-7300.9 Limitation on Liability Determination Does Not Affect Medicare Exclusion 30 100.10 A3-3446.9 B3-7320.10  Exhibits 30 110 Contractor Instructions for Application of Limitation On Liability (Section heading only) 30 110.1 A3-3441 Payment Under Limitation on Liability 30 110.2 A3-3442 When to Make Limitation on Liability Decisions 30 110.3 A3-3443 Preparation of Denial Notices 30 110.4 A3-3445 Bill Processing 30 120 B3-7300,B3-7320.10 Carrier Specific Instructions for Application of Limitation on Liability (Section heading only) New Chap. New Sect. Int.  Pub. 13 Carrier Pub. 14 PMs Other Description 30                                                                120.1 B3-7300.6 Documentation of Notices Regarding Coverage 30 120.2 B3-7300.7 Availability of Coverage Notices to Operating Personnel 30 120.3 B3-7300.10  Applicability of Limitation on Liability Provision to Claims for Outpatient Physical Therapy Services Furnished by Clinics 30 120.4 B3-7300.4 Limitation on Liability Notices to Beneficiaries from Carriers 30 120.5 B3-7300.4B2 Carrier Reviews in Assignment Cases Conducted at the Request of Either the Beneficiary or the Assignee 30 120.5.1 B3-7300.4C Guide Paragraphs for Carriers to Use Where 1879 Is Applicable at Review Level 30 130 Intermediary Specific Instructions for Application of Limitation on Liability 30 130.1 A3-3444 Applicability of the Limitation on Liability Provision to Claims for Ancillary, Outpatient Provider and Rural Health Clinic Services Payable Under Part B 30 130.1.1 A3-3444.1 Determining Beneficiary Liability in Claims for Ancillary and Outpatient Services 30 130.1.2 A3-3444.2 Determining Provider Liability in Claims for Ancillary and Outpatient Services 30 130.2 A3-3431.1 Prior Hospitalization and Transfer Requirements for SNF Coverage as Related to Limitation on Liability New Chap. New Sect. Int.  Pub. 13 Carrier Pub. 14 PMs Other Description 30            130.3 A3-3431.2 Application of Limitation on Liability to SNF and Hospital Claims for Services Furnished in Noncertified or Inappropriately Certified Beds 30 130.4 A3-3431.3 Determining Liability for Services Furnished in a Noncertified SNF or Hospital Bed 30 140 - 140.12 B3-7330    Physician Refund Requirements (RR) Provision for Nonassigned Claims for Physicians Services Under 1842(l) - Instructions for Carriers and Physicians 30 150 - 150.15    AB-02-168 Part I  DMEPOS Refund Requirements (RR) Provision for Claims for Medical Equipment and Supplies under 1834(a)(18), 1834(j)(4), and 1879(h) - Instructions for Carriers and Suppliers