(Medicare Claims Processing Manual)

 A SNF may request and accept payment for a Part A deductible and coinsurance amount on or after the day to which it applies.   A SNF may request and accept payment for a Part B deductible and coinsurance amount at the time of or after the provision of the service to which it applies.   A SNF may not request or accept advance payment of Medicare deductible and coinsurance amounts.   A SNF may require, request, or accept a deposit or other payment for services if it is clear that the services are not covered by Medicare and proper notice is provided. See Chapter 30 for instructions about ABNs and demand bills.   SNFs, but not hospitals, may bill the beneficiary for holding a bed during a leave of absence if the requirements in 30.1.1.1 are met.  30.1.1.1 - Charges to Hold a Bed During SNF Absence  (Rev. 4001, Issued: 03- 16-18, Effective: 06 - 19- 18, Implementation: 06- 19-18)  Charges to the beneficiary for admission or readmission are not allowable.  However, when temporarily leaving a SNF, a resident can choose to make bed- hold payments to the SNF.   Bed-hold payments are readily distinguishable from payments made prior to initial admission, in that the absent individual has already been admitted to the facility and has established residence in a particular living space within it.  Similarly, bed -hold payments are distinguishable from payments for readmission, in that the latter compensate the facility merely for agreeing in advance to allow a departing resident to reenter the facility upon return, while bed -hold payments represent remuneration for the privilege of actually maintaining the residents personal effects in the particular living space that the resident has temporarily vacated.   One indicator that post -admission payments do, in fact, represent permissible bed- hold charges related to maintaining personal effects in a particular living space (rather than a prohibited charge for the act of readmission itself) would be that the charge s are calculated on the basis of a per diem bed -hold payment rate multiplied by however many days the resident is absent, as opposed to assessing the resident a fixed sum at the time of departure from the facility.   Under 1819(c)(1)(B)(iii) of the Act and 42 CFR 483.10(g)(17) -(18), the facility must inform residents in advance of their option to make bed- hold payments, as well as the amount of the facilitys charge.  For these optional payments, the facility should m ake clear that the resident must affirmatively elect to make them prior to being billed.  A facility cannot simply deem a resident to have opted to make such payments and then automatically bill for them upon the residents departure from the facility.   30.1.2 - Provider Refunds to Beneficiaries  (Rev. 1, 10- 01-03) RHC- 322  In the agreement between CMS and a provider, the provider agrees to refund as promptly as possible any money incorrectly collected from Medicare beneficiaries or from someone on their behalf.   Money incorrectly collected means any amount for covered services that is greater than the amount for which the beneficiary is liable because of the deductible and coinsurance requirements.   Amounts are considered to have been incorrectly collected because the provider believed the beneficiary was not entitled to Medicare benefits but:    The beneficiary was later determined to have been entitled to Medicare benefits;    The beneficiarys entitlement period fell within the time the providers agreement with CMS was in effect; and    Such amounts exceed the beneficiarys deductible, coinsurance or non covered services liability.     30.1.3 - Provider Treatment of Beneficiaries  (Rev.4163, Issued: 11- 02-18, Effective: 12 -04-18, Implementation: 12- 04-18)  In the agreement between CMS and a provider, the provider agrees to accept Medicare beneficiaries for care and treatment.  The provider cannot impose any limitations with respect to care and treatment of Medicare beneficiaries that it does not also impose on all other persons seeking care and treatment.  If the provider does not furnish treatment for certain illnesses and conditions to patients who are not Medicare beneficiaries, it need not furnish such treatment to Medicare beneficiaries in order to participate in the Medicare program.  It may not, however, refuse to furnish treatment for certain ill nesses or conditions to Medicare beneficiaries if it furnishes such treatment to others.  Failure to abide by this rule is a cause for termination of the providers agreement to participate in the Medicare program (see the regulations at 42 CFR 489.53(a)(2), and also see Pub. 100-01, Medicare General Information, Eligibility, and Entitlement Manual, chapter 5, 10.2).  30.2 - Assignment of Providers Right to Payment  (Rev. 1, 10-01-03) A3-3488, A3-3703.1, B3-3060  Except as provided in 30.2.1, FIs pay benefits due a provider only to the provider.  Carriers may pay assigned benefits only to the physician, practitioner, or supplier who furnished the service.  They do not pay the benefits to any other person or organization under an assignment or reassignment, power of attorney, or under any other arrangement in which the other person or organization receives the payment directly.  For this purpose, assigned benefits include, in addition to the benefits usually encompassed by this term, benefits payable after the death of the enrollee to the physician or other supplier on the basis of his agreement to accept the reasonable charge as the full charge.  A power of attorney for this purpose means a written authorization by a principal to an agent:   To receive in the agents own name amounts due the principal;  To negotiate checks payable to the principal; or  To receive in any other manner direct payment of amounts due the principal.  The prohibition against assignment of a providers benefits also applies to payment of benefits due a provider as a reassignee of the physician.  Payment is considered to be made directly to an ineligible person or organization if that person or organization can convert the payment to its own use and control without the payment first passing through the control of the provider or other party eligibl e to receive the payment under the exceptions in 30.2.1. (For payment to a bank, see 30.2.5.)  Forwarding of amounts due a provider to its home office is not affected by the prohibition described in this section. Reimbursement amounts for providers of a chain organization may be forwarded to a central location of the home office when it has set up a lock box or special bank account and the FI has secured a written  assignment or other authorization from the respective provider(s) that payment may be sent to the home office.  The payments must be made out in the individual providers name and payment may be made by check or electronic funds transfer (EFT).  Establishment of internal controls and other related administrative details necessary to effect these payments are left to the individual contractors involved.  However, FIs must be sure that the individual signing the assignment can legally bind the provider. Payment under those procedures is payment to the provider.   30.2.1 - Exceptions to Assignment of Providers Right to Payment   Claims Submitted to A/B MACs (Rev.  3774, 05- 12-17, Effective: 06- 13-17, Implementation: 06- 13-17)  A.  Payment to Government Agency  Medicare payment for the services of a provider is not made to a governmental agency or entity except when payment to the governmental agency or entity is permissible under the other listed reassignment exceptions, e.g., where the agency is the employer of the physician.  B.  Payment Pursuant to Court Order   The Medicare program may make payment in accordance with an assignment established by, or pursuant to the order of, a court of competent jurisdiction.  The assignment must satisfy the conditions set forth in 30.2.  C.  Payment to Agent   The Medicare program may make payment, in the name of the provider, to an agent who furnishes billing or collection services.  The payment arrangement must satisfy the conditions in 30.2.4.  D.  Payment to Employer   The A/B MAC Part B may pay the employer of the physician or other supplier if the physician or other supplier is required, as a condition of his employment, to turn over to his employer the fees for his services. (See 30.2.6 .)  E.  Payment for Services Provided Under a Contractual Arrangement   The A/B MAC Part B  may make payment to an entity enrolled in the Medicare program for services provided by a physician or other person under a contractual arrangement with that entity.  The services may be furnished on or off the premises of the entity submitting the claim.   Both, the entity submitting the claim and receiving payment and the physician or other person under contract are subject to certain program integrity requirements.  (See 30.2.7.)   F.  Payment for Anti -Markup Tests   The A/B MAC Part B may pay a physician (or a physicians medical group) or other supplier for the TC or PC of diagnostic tests (other than clinical diagnostic laboratory tests) that the physician or other supplier contracts an independent physician, medical group, or other supplier to perform.  The anti -markup payment limitation applies when the performing physician or other supplier does not meet the criteria for sharing a practice with the billing physician or other supplier.  The contracting physician, physicians group, or other supplier must accept as payment in full the lower of: (a) the acquisition price; (b) the submitted charge for the service; or (c) the fee schedule amount.  (See 30.2.9, of this chapter, for additional information on the anti -markup payment limitation.)   G.  Payment Under Reciprocal Billing Arrangements   The A/B MAC Part B may pay the patients regular physician for physicians services and services furnished incident to such services that are provided to the regular physicians patients by another physician on an occasional reciprocal basis and certain other requirem ents are met.  Also, in the case of outpatient physical therapy services furnished by physical therapists in a health professional shortage area (HPSA), a medically underserved area (MUA), or a rural area, the A/B MAC Part B may pay the patients regular physical therapist for such services that are provided to his/her patients by another physical therapist on an occasional reciprocal basis and certain other requirements are met.  (See 30.2.10.)   H.  Payment Under Fee -For-Time Compensation Arrangements (formerly referred to as Locum Tenens Arrangements)   The A/B MAC Part B may pay the patients regular physician for physicians' services and services furnished incident to such services that are provided by a substitute physician during the absence of the regular physician where the regular physician pays the substitute  on a per diem or similar fee -for-time basis, and certain other requirements are met.  Also, in the case of outpatient physical therapy services furnished by physical therapists in a HPSA, a MUA, or a rural area, the A/B MAC Part B may pay the patients regular physical therapist for such services that are provided by a substitute physical therapist where the regular physical therapist pays the substitute on a per diem or similar fee-for-time basis, and certain other requirements are met.  (See 30.2.11.)   30.2.2 - Background and Purpose of Reassignment Rules - Claims Submitted to B/MACs  (Rev. 1931, Issued: 03- 12-10, Effective: 06 -14-10, Implementation: 06- 14-10)  In 1972, Congress acted to stop a practice under which some physicians and other suppliers providing covered services reassigned their Medicare and Medicaid receivables to other organizations and groups, which then claimed and received payment.  Often the organizations acquired the claims at a percentage of face value.  It had become apparent that such reassignments were a source of incorrect, inflated, and even fraudulent Medicare and Medicaid claims.  The Social Security Act Amendments of 1972, Public Law 92-603, enacted a prohibition against payment on a charge basis for covered services to anyone other than the patient, physician or other person who provided the service, with limited exceptions.   Thereafter, some physicians and other suppliers circumvented the intent of the law by granting a power of attorney.  This allowed the factoring company or other person to receive the Medicare or Medicaid payments in the name of the physician or other suppl ier, thus permitting continuation of program abuses.   Section 2(a) of Public Law 95- 142, dated October 25, 1977, modified existing law to preclude the use of power of attorney as a device for reassignment of benefits under Medicare, subject to limited exceptions.  It also provides for a similar prohibition wi th respect to payment for care furnished by providers.  These provisions preclude Medicare payment of amounts due a provider or other person to a person or entity furnishing financing to the provider, whether the provider sells the providers claims to that person or entity or pledges them to that person or ent ity as collateral on a loan.   A.  Who is Supplier of Services   The question of reassignment arises only when assigned payment is made to someone other than the physician or other practitioner or supplier that furnished the services.