Source: http://www.law.cornell.edu/cfr/text/42/424.30
Timestamp: 2014-07-28 17:11:32
Document Index: 222317359

Matched Legal Cases: ['art 424', '§ 424', '§ 412', '§ 413', '§ 413', '§ 412']

42 CFR 424.30 - Scope. | LII / Legal Information Institute
CFR › Title 42 › Chapter IV › Subchapter B › Part 424 › Subpart C › Section 424.30 42 CFR 424.30 - Scope.
§ 424.30
This subpart sets forth the requirements, procedures, and time limits for claiming Medicare payments. Claims must be filed in all cases except when services are furnished on a prepaid capitation basis by an MA organization, or through cost settlement with either a health maintenance organization (HMO), a competitive medical plan (CMP), or a health care prepayment plan (HCPP), or as part of a demonstration. Therefore, claims must be filed by hospitals seeking IME payment under § 412.105(g) of this chapter, and/or direct GME payment under § 413.76(c) of this chapter, and/or nursing or allied health education payment under § 413.87 of this chapter associated with inpatient services furnished on a prepaid capitation basis by an MA organization. Hospitals that must report patient data for purposes of the DSH payment adjustment under § 412.106 of this chapter for inpatient services furnished on a prepaid capitation basis by an MA organization, or through cost settlement with an HMO/CMP, or as part of a demonstration, are required to file claims by submitting no pay bills for such inpatients. Special procedures for claiming payment after the beneficiary has died and for certain bills paid by organizations are set forth in subpart E of this part.
[77 FR 53682, Aug. 31, 2012]