evekhm/cms_iom_500 huggingface dataset:
2.2_Deductible_PartB_120907.pdf
You have now met your $162.00 deductible for 2008. You have now met your $162.00 deductible for 2009. You have now met $62.00  of your $162.00  deductible for 2011.Be Informed!Register at www.MyMedicare.gov for direct access to your Original Medicare claims, track your preventive services and print an On the Go report to share with your provider. Visit the Web site to sign up and access your personal Medicare information.THIS IS NOT A BILLJENNIFER WASHINGTON  TEMPORARY ADDRESS NAMESTREET ADDRESSCITY, ST 12345-6789Your Claims & Costs This PeriodDid Medicare Approve All Claims? NONumber of Services Medicare Denied 2See claims starting on page 3. Look for NO in the Service Approved? column. See the last page for how to handle a denied claim. Total You May Be Billed $150.86Providers with Claims This PeriodJune 18, 2011  Susan Jones, M.D.June 28, 2011  Craig I. Secosan, M.D. June 29  June 30, 2011  Edward J. Mcginley M.D. Saba que puede recibir este aviso y otro tipo de ayuda de Medicare en espaol? Llame y hable con un agente en espaol.     agent ,  Mandarin .                   1-800-MEDICARE (1-800-633-4227)Page 1 of 5Notice for Jennifer WashingtonMedicare Number XXX-XX-1234ADate of This Notice September 16, 2011Claims Processed  BetweenJune 15   September 15, 2011Exhibit 2.2c  Part B Deductible: Multiple Met and Unmet
2.3_Deductible_Benefit_120907.pdf
Page 1 of 5Medicare Summary Noticefor Part A (Hospital Insurance) The Official Summary of Your Medicare Claims from the Centers for Medicare & Medicaid ServicesYour Deductible StatusYour deductible is what you must pay each benefit period for most health services before Medicare begins to pay. Part A Deductible:  You have now met $798.00  of your $1,068.00  deductible for inpatient hospital  services for the benefit period that began May 27, 2011.Be Informed!Register at www.MyMedicare.gov for direct access to your Original Medicare claims, track your preventive services and print an On the Go report to share with your provider. Visit the Web site to sign up and access your personal Medicare information.THIS IS NOT A BILLJENNIFER WASHINGTON  TEMPORARY ADDRESS NAMESTREET ADDRESSCITY, ST 12345-6789Saba que puede recibir este aviso y otro tipo de ayuda de Medicare en espaol? Llame y hable con un agente en espaol.     agent ,  Mandarin .                   1-800-MEDICARE (1-800-633-4227)Your Claims & Costs This PeriodDid Medicare Approve All Claims? NONumber of Services Medicare Denied 2See claims starting on page 3. Look for NO in the Claim Approved? column. See the last page for how to handle a denied claim. Total You May Be Billed $0.00Facilities with Claims This PeriodJune 18  June 20, 2011  Otero HospitalJune 29  August 03, 2011  The New York and Presbyterian HospitalNotice for Jennifer WashingtonMedicare Number XXX-XX-1234ADate of This Notice September 16, 2011Claims Processed  BetweenJune 15   September 15, 2011Exhibit 2.3a  Part A Deductible and Benefit Days: InpatientTHIS IS NOT A BILL | Page 2 of 5 Jennifer WashingtonMaking the Most of Your Medicare
2.3_Deductible_Benefit_120907.pdf
How to Check This NoticeDo you recognize the name of each facility?  Check the dates.Did you get the claims listed?  Do they match those listed on your receipts and bills? If you already paid the bill, did you pay the right amount?  Check the maximum you may be billed. See if the claim was sent to your Medicare supplement insurance (Medigap) plan or other insurer. That plan may pay your share.  How to Report FraudIf you think a facility or business is involved in fraud, call us at 1-800-MEDICARE (1-800-633-4227).Some examples of fraud include offers for free medical services, or billing you for Medicare services you didnt get. If we determine that your tip led to uncovering fraud, you may qualify for a reward.You can make a difference!  Last year, Medicare saved tax-payers $4 billion the largest sum ever recovered in a single yearthanks to people who reported suspicious activity to Medicare.  How to Get Help with Your Questions1-800-MEDICARE (1-800-633-4227)  Ask for hospital services. Your customer-service code is 05535.TTY 1-877-486-2048 (for hearing impaired)Contact your State Health Insurance Program (SHIP) for free, local health insurance counseling. Call 1-555-555-5555 .  Your Benefit PeriodsYour hospital and skilled nursing facility (SNF) stays are measured in benefit days  and benefit periods . Every day that you spend in a hospital or SNF counts toward the benefit days in that benefit period. A benefit period begins the day you first receive inpatient hospital services or, in certain circumstances, SNF services, and ends when you havent received any inpatient care in a hospital or inpatient skilled care in an SNF for 60 days in a row. Inpatient Hospital: You have 27 out of 90 covered benefit days  remaining for the benefit period that began May 27, 2011.See your Medicare & You handbook for more information on benefit periods.
2.3_Deductible_Benefit_120907.pdf
Your Messages from MedicareGet a pneumococcal shot.  You may only need it once in a lifetime. Contact your health care provider about getting this shot. You pay nothing if your health care provider accepts Medicare assignment.To report a change of address , call Social Security at 1-800-772-1213. TTY users should call  1-800-325-0778.Early detection is your best protection.  Schedule your mammogram today, and remember that Medicare helps pay for screening mammograms. Do you use therapy services? Watch the limit! In 2011, Medicares annual coverage limit for most outpatient physical therapy and speech language pathology is $1,860 combined.Exhibit 2.3a  Part A Deductible and Benefit Days: InpatientMedicare Summary Noticefor Part A (Hospital Insurance) The Official Summary of Your Medicare Claims from the Centers for Medicare & Medicaid ServicesYour Deductible StatusYour deductible is what you must pay each benefit period for most health services before Medicare begins to pay. Part A Deductible:  You have now met $0.00  of your $1,068.00  deductible for inpatient hospital  services for the benefit period that began June 5, 2010. Be Informed!Register at www.MyMedicare.gov for direct access to your Original Medicare claims, track your preventive services and print an On the Go report to share with your provider. Visit the Web site to sign up and access your personal Medicare information.THIS IS NOT A BILLJENNIFER WASHINGTON  TEMPORARY ADDRESS NAMESTREET ADDRESSCITY, ST 12345-6789Saba que puede recibir este aviso y otro tipo de ayuda de Medicare en espaol? Llame y hable con un agente en espaol.     agent ,  Mandarin .                   1-800-MEDICARE (1-800-633-4227)Your Claims & Costs This PeriodDid Medicare Approve All Claims? NONumber of Services Medicare Denied 2See claims starting on page 3. Look for NO in the Claim Approved? column. See the last page for how to handle a denied claim. Total You May Be Billed $2,062.50Facilities
2.3_Deductible_Benefit_120907.pdf
of Services Medicare Denied 2See claims starting on page 3. Look for NO in the Claim Approved? column. See the last page for how to handle a denied claim. Total You May Be Billed $2,062.50Facilities with Claims This PeriodJune 18  June 20, 2011  Otero HospitalJune 29  August 03, 2011  The New York and Presbyterian HospitalPage 1 of 5Notice for Jennifer WashingtonMedicare Number XXX-XX-1234ADate of This Notice September 16, 2011Claims Processed  BetweenJune 15   September 15, 2011Exhibit 2.3b  Part A Deductible and Benefit Days: Inpatient & SNFTHIS IS NOT A BILL | Page 2 of 5 Jennifer WashingtonMaking the Most of Your Medicare
2.3_Deductible_Benefit_120907.pdf
How to Check This NoticeDo you recognize the name of each facility?  Check the dates.Did you get the claims listed?  Do they match those listed on your receipts and bills? If you already paid the bill, did you pay the right amount?  Check the maximum you may be billed. See if the claim was sent to your Medicare supplement insurance (Medigap) plan or other insurer. That plan may pay your share.  How to Report FraudIf you think a facility or business is involved in fraud, call us at 1-800-MEDICARE (1-800-633-4227).Some examples of fraud include offers for free medical services, or billing you for Medicare services you didnt get. If we determine that your tip led to uncovering fraud, you may qualify for a reward.You can make a difference!  Last year, Medicare saved tax-payers $4 billion the largest sum ever recovered in a single yearthanks to people who reported suspicious activity to Medicare.  How to Get Help with Your Questions1-800-MEDICARE (1-800-633-4227)  Ask for hospital services. Your customer-service code is 05535.TTY 1-877-486-2048 (for hearing impaired)Contact your State Health Insurance Program (SHIP) for free, local health insurance counseling. Call 1-555-555-5555 .  Your Benefit PeriodsYour hospital and skilled nursing facility (SNF) stays are measured in benefit days  and benefit periods . Every day that you spend in a hospital or SNF counts toward the benefit days in that benefit period. A benefit period begins the day you first receive inpatient hospital services or, in certain circumstances, SNF services, and ends when you havent received any inpatient care in a hospital or inpatient skilled care in an SNF for 60 days in a row. Inpatient Hospital: You have 27 out of 90 covered days  remaining for the benefit period that began June 5, 2010.Skilled Nursing Facility: You have 63 out of 100 covered days  remaining for the benefit period that began June 5, 2010.See your Medicare & You handbook for more information on benefit periods.
2.3_Deductible_Benefit_120907.pdf
Your Messages from MedicareGet a pneumococcal shot.  You may only need it once in a lifetime. Contact your health care provider about getting this shot. You pay nothing if your health care provider accepts Medicare assignment.To report a change of address , call Social Security at 1-800-772-1213. TTY users should call  1-800-325-0778.Early detection is your best protection.  Schedule your mammogram today, and remember that Medicare helps pay for screening mammograms. Do you use therapy services? Watch the limit! In 2011, Medicares annual coverage limit for most outpatient physical therapy and speech language pathology is $1,860 combined.Exhibit 2.3b  Part A Deductible and Benefit Days: Inpatient & SNFMedicare Summary Noticefor Part A (Hospital Insurance) and Part B (Medical Insurance) The Official Summary of Your Medicare Claims from the Centers for Medicare & Medicaid ServicesYour Deductible StatusYour deductible is what you must pay each benefit period for most health services before Medicare begins to pay. Part A Deductible:  You have now met $0.00  of your $1,068.00  deductible for inpatient hospital  services for the benefit period that began June 5, 2010. Part B Deductible: You have now met your $162.00 deductible for 2009. You have now met your$162.00 deductible for 2010. You have now met $85.00  of your $162.00  deductible for 2011.Be Informed!Register at www.MyMedicare.gov for direct access to your Original Medicare claims, track your preventive services and print an On the Go report to share with your provider. Visit the Web site to sign up and access your personal Medicare information.THIS IS NOT A BILLJENNIFER WASHINGTON  TEMPORARY ADDRESS NAMESTREET ADDRESSCITY, ST 12345-6789Saba que puede recibir este aviso y otro tipo de ayuda de Medicare en espaol? Llame y hable con un agente en espaol.     agent ,  Mandarin .                   1-800-MEDICARE
2.3_Deductible_Benefit_120907.pdf
y hable con un agente en espaol.     agent ,  Mandarin .                   1-800-MEDICARE (1-800-633-4227)Your Claims & Costs This PeriodDid Medicare Approve All Claims? NONumber of Services Medicare Denied 2See claims starting on page 3. Look for NO in the Claim Approved? column. See the last page for how to handle a denied claim. Total You May Be Billed $2,062.50Facilities with Claims This PeriodJune 18  June 20, 2011  Otero HospitalJune 29  August 03, 2011  The New York and Presbyterian HospitalPage 1 of 5Notice for Jennifer WashingtonMedicare Number XXX-XX-1234ADate of This Notice September 16, 2011Claims Processed  BetweenJune 15   September 15, 2011Exhibit 2.3c  Part A Deductible and Benefit Days: Part A and B of A combinedTHIS IS NOT A BILL | Page 2 of 5 Jennifer WashingtonMaking the Most of Your Medicare
2.3_Deductible_Benefit_120907.pdf
How to Check This NoticeDo you recognize the name of each facility?  Check the dates.Did you get the claims listed?  Do they match those listed on your receipts and bills? If you already paid the bill, did you pay the right amount?  Check the maximum you may be billed. See if the claim was sent to your Medicare supplement insurance (Medigap) plan or other insurer. That plan may pay your share.  How to Report FraudIf you think a facility or business is involved in fraud, call us at 1-800-MEDICARE (1-800-633-4227).Some examples of fraud include offers for free medical services, or billing you for Medicare services you didnt get. If we determine that your tip led to uncovering fraud, you may qualify for a reward.You can make a difference!  Last year, Medicare saved tax-payers $4 billion the largest sum ever recovered in a single yearthanks to people who reported suspicious activity to Medicare.  How to Get Help with Your Questions1-800-MEDICARE (1-800-633-4227)  Ask for hospital services. Your customer-service code is 05535.TTY 1-877-486-2048 (for hearing impaired)Contact your State Health Insurance Program (SHIP) for free, local health insurance counseling. Call 1-555-555-5555 .  Your Benefit PeriodsYour hospital and skilled nursing facility (SNF) stays are measured in benefit days  and benefit periods . Every day that you spend in a hospital or SNF counts toward the benefit days in that benefit period. A benefit period begins the day you first receive inpatient hospital services or, in certain circumstances, SNF services, and ends when you havent received any inpatient care in a hospital or inpatient skilled care in a SNF for 60 days in a row. Inpatient Hospital: You have used all of your 90 covered benefit days for the benefit period that began June 5, 2010.Inpatient Lifetime Reserve:  You have 37 days out of 60 reserve days  remaining.Inpatient Mental Health:  You have 185 days out of 190 mental health care days  remaining.Skilled Nursing Facility: You have 63 days out of 100 covered days  remaining for the benefit period that began June 5, 2010.
2.3_Deductible_Benefit_120907.pdf
Your Messages from MedicareGet a pneumococcal shot.  You may only need it once in a lifetime. Contact your health care provider about getting this shot. You pay nothing if your health care provider accepts Medicare assignment.To report a change of address , call Social Security at 1-800-772-1213. TTY users should call  1-800-325-0778.Early detection is your best protection.  Schedule your mammogram today, and remember that Medicare helps pay for screening mammograms. Do you use therapy services? Watch the limit! In 2011, Medicares annual coverage limit for most outpatient physical therapy and speech language pathology is $1,860 combined.Exhibit 2.3c  Part A Deductible and Benefit Days: All benefit status days activeTHIS IS NOT A BILL | Page 2 of 5 Jennifer WashingtonMaking the Most of Your Medicare   How to Check This NoticeDo you recognize the name of each facility?  Check the dates.Did you get the claims listed?  Do they match those listed on your receipts and bills? If you already paid the bill, did you pay the right amount?  Check the maximum you may be billed. See if the claim was sent to your Medicare supplement insurance (Medigap) plan or other insurer. That plan may pay your share.  How to Report FraudIf you think a facility or business is involved in fraud, call us at 1-800-MEDICARE (1-800-633-4227).Some examples of fraud include offers for free medical services, or billing you for Medicare services you didnt get. If we determine that your tip led to uncovering fraud, you may qualify for a reward.You can make a difference!  Last year, Medicare saved tax-payers $4 billion the largest sum ever recovered in a single yearthanks to people who reported suspicious activity to Medicare.
2.3_Deductible_Benefit_120907.pdf
How to Get Help with Your Questions1-800-MEDICARE (1-800-633-4227)  Ask for hospital services. Your customer-service code is 05535.TTY 1-877-486-2048 (for hearing impaired)Contact your State Health Insurance Program (SHIP) for free, local health insurance counseling. Call 1-555-555-5555 .  Your Benefit PeriodsYour hospital and skilled nursing facility (SNF) stays are measured in benefit days  and benefit periods . Every day that you spend in a hospital or SNF counts toward the benefit days in that benefit period. A benefit period begins the day you first receive inpatient hospital services or, in certain circumstances, SNF services, and ends when you havent received any inpatient care in a hospital or inpatient skilled care in an SNF for 60 days in a row. Inpatient Hospital: You have used all of your 90 covered benefit days for the benefit period that began June 5, 2010.Inpatient Lifetime Reserve:  You have used all of your 60 lifetime reserve days.Inpatient Mental Health:  You have used all of your 190 mental health care days.Skilled Nursing Facility: You have used all of your 100 covered benefit days for the benefit period that began June 5, 2010.  Your Messages from MedicareGet a pneumococcal shot.  You may only need it once in a lifetime. Contact your health care provider about getting this shot. You pay nothing if your health care provider accepts Medicare assignment.To report a change of address , call Social Security at 1-800-772-1213. TTY users should call  1-800-325-0778.Early detection is your best protection.  Schedule your mammogram today, and remember that Medicare helps pay for screening mammograms. Do you use therapy services? Watch the limit! In 2011, Medicares annual coverage limit for most outpatient physical therapy and speech language pathology is $1,860 combined.Exhibit 2.3d  Part A Deductible and Benefit Days: All benefit status used
2.4_ProviderList_120907.pdf
Page 1 of 5Medicare Summary Noticefor Part B (Medical Insurance)The Official Summary of Your Medicare Claims from the Centers for Medicare & Medicaid ServicesYour Deductible StatusYour deductible is what you must pay for most health services before Medicare begins to pay. Part B Deductible:  You have now met $85.00  of your $162.00  deductible for 2011. Be Informed!Register at www.MyMedicare.gov for direct access to your Original Medicare claims, track your preventive services and print an On the Go report to share with your provider. Visit the Web site to sign up and access your personal Medicare information.THIS IS NOT A BILLJENNIFER WASHINGTON  TEMPORARY ADDRESS NAMESTREET ADDRESSCITY, ST 12345-6789Your Claims & Costs This PeriodDid Medicare Approve All Claims? NONumber of Services Medicare Denied 2See claims starting on page 3. Look for NO in the Service Approved? column. See the last page for how to handle a denied claim. Total You May Be Billed $150.86Providers with Claims This PeriodJune 18, 2011  Susan Jones, M.D.June 28, 2011  Craig I. Secosan, M.D. June 29  June 30, 2011  Edward J. Mcginley M.D. July 28  July 29, 2011  Dr. Andrew Star, M.D. August 18, 2011  Jonathan Smith, M.D.August 28, 2011  Richard Lee, M.D.You saw more providers this period. Go to your complete list of claims, starting on page 3.Saba que puede recibir este aviso y otro tipo de ayuda de Medicare en espaol? Llame y hable con un agente en espaol.     agent ,  Mandarin .                   1-800-MEDICARE (1-800-633-4227)Notice for Jennifer WashingtonMedicare Number XXX-XX-1234ADate of This Notice September 16, 2011Claims Processed  BetweenJune 15   September 15, 2011Exhibit 2.4  Provider List with Tag
2.5_ProviderHeader_120622.pdf
Benefit  Days UsedItem Approved?Non- Covered ChargesAmount Medicare PaidMaximum You May Be BilledSee  Notes BelowBenefit Period starting June 18, 2011 4 days Yes $0.00 $4,886.98 $0.00Total for Claim #20905400034102 $0.00 $4,886.98 $0.00 AJune 18  June 20, 2011Otero Hospital, (555) 555-1234 PO Box 1142, Manati, PR 00674Referred by Dr. Jesus Sarmiento ForastiExhibit 2.5a  Provider Header Format: Part AService Provided & Billing CodeService Approved?Amount Provider ChargedMedicare- Approved AmountAmount Medicare PaidMaximum You May Be BilledSee  Notes BelowTherapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minut (97110)Yes $45.00 $28.54 $22.83 $5.71Total for Claim #02-10195-592-677 $45.00 $28.54 $22.83 $5.71 AService Provided & Billing CodeItem Approved?Amount Provider ChargedMedicare- Approved AmountAmount Medicare PaidMaximum You May Be BilledSee  Notes BelowJune 29, 2010Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report (93010)NO $55.00 $0.00 $0.00 $55.00 D,E,FJune 30, 2010Destruction of skin growth (17000) NO 68.56 0.00 0.00 68.56 DTotal for Claim #02-10204-674-840 $123.56 $0.00 $0.00 $123.56June 18, 2011Aisa G. Lopez, (555) 555-1234 8046 Crittenden St, Philadelphia, PA 19118-0000 Referred by Roy K AugusthyJune 29  June 30, 2011Edward J. Mcginley, M.D., (555) 555-1234 Nazareth Cardiology PC, 3037 Smith Ave, Philadelphia, PA 19182-0001 Referred by Hanh-Nhon DoanExhibit 2.5b  Provider Header Format: Part B Service Provided & Billing CodeService Approved?Amount Facility ChargedMedicare- Approved
2.5_ProviderHeader_120622.pdf
Philadelphia, PA 19182-0001 Referred by Hanh-Nhon DoanExhibit 2.5b  Provider Header Format: Part B Service Provided & Billing CodeService Approved?Amount Facility ChargedMedicare- Approved AmountAmount Medicare PaidMaximum You May Be BilledSee  Notes BelowLiver function blood test panel (80076)Yes $69.46 $69.46 $69.46 $0.00 ALiver function blood test panel (80076)Yes 69.46 69.46 69.46 0.00 ALiver function blood test panel (80076)Yes 69.46 69.46 69.46 0.00 ALiver function blood test panel (80076)Yes 69.46 69.46 69.46 0.00 ALiver function blood test panel (80076)Yes 69.46 69.46 69.46 0.00 ALiver function blood test panel (80076)Yes 69.46 69.46 69.46 $0.00 ALiver function blood test panel (80076)Yes 69.46 69.46 69.46 $0.00 ATotal for Claim #21035000422104NYA $486.22 $486.22 $486.22 $0.00July 19  August 22, 2011The New York and Presbyterian Hospital, (555) 555-1234 525 East 68th Street, New York NY 10065-4870Referred by Selim M. ArcasoyExhibit 2.5c  Provider Header Format: B of A Quantity, Item/Service Provided &  Billing CodeItem/ Service Approved?Amount Supplier ChargedMedicare- Approved AmountAmount Medicare PaidMaximum You May Be BilledSee  Notes Below1 Oxygen Concentrator (E1390-RR) RentalYes $442.00 $173.17 $138.54 $34.63 ATotal for Claim #10334829487000 $442.00 $173.17 $138.54 $34.63 BMay 9, 2011Lincare Inc., (555) 555-1234 PO BOX 996, Blue Springs, MO 64013-0996 Ordered by John K WhalenExhibit 2.5d  Provider Header Format: DME