42 CFR 405.502 - Criteria for determining reasonable charges

Cite as42 CFR 405.502
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39 practice notes
  • Introduction to Regulatory Plan and Unified Agenda of Federal Regulatory and Deregulatory Actions, 64075-64305 [05-21048]
    • United States
    • Federal Register October 31, 2005
    • October 31, 2005
    ...(CMS- 1270-P) Priority: Economically Significant. Major under 5 USC 801. Legal Authority: PL 108-173, MMA CFR Citation: 42 CFR 414.200; 42 CFR 405.502(g); 42 CFR 424.57; 42 CFR 410.38 Legal Deadline: Final, Statutory, January 1, 2007. Abstract: Section 302 of the Medicare Modernization Act ......
  • Nmc Homecare, Inc. v. Shalala, Civil Action No. 3:cv-95-1922.
    • United States
    • United States District Courts. 3th Circuit. United States District Court of Middle District of Pennsylvania
    • July 18, 1997
    ...surgical dressing kits from $30.00 to $8.00 violated due process because it was contrary to the notice and comment consistent with 42 C.F.R. § 405.502(g). In addition, the plaintiffs also complained that their due process was violated because of the retroactive effect of the notice on the p......
  • Walsh v. McGee, No. 89 Civ. 1310 (DNE).
    • United States
    • United States District Courts. 2nd Circuit. United States District Courts. 2nd Circuit. Southern District of New York
    • October 11, 1995
    ...in making these determinations, a carrier may take into account additional factors that it deems necessary to its evaluation. 42 C.F.R. § 405.502(a)(7). If a carrier finds that the claim meets all coverage criteria, it pays enrollee's benefits from federal funds according to Medicare guidel......
  • NAT. ASS'N OF PATIENTS ON HEMODIALYSIS AND TRANSPLANTATION, INC. v. Heckler, Civ. A. No. 83-2210.
    • United States
    • United States District Courts. United States District Court (Columbia)
    • June 11, 1984
    ...of reasonable cost reimbursement for providers and reasonable charge reimbursement for physicians and suppliers. 42 C.F.R. §§ 402(g), 405.502(e), 405.541-405.544. Under these rules, which were in effect until August 1, 1983, hospital dialysis facilities were paid 80 percent of the "rea......
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25 cases
  • Nmc Homecare, Inc. v. Shalala, Civil Action No. 3:cv-95-1922.
    • United States
    • United States District Courts. 3th Circuit. United States District Court of Middle District of Pennsylvania
    • July 18, 1997
    ...surgical dressing kits from $30.00 to $8.00 violated due process because it was contrary to the notice and comment consistent with 42 C.F.R. § 405.502(g). In addition, the plaintiffs also complained that their due process was violated because of the retroactive effect of the notice on the p......
  • Walsh v. McGee, No. 89 Civ. 1310 (DNE).
    • United States
    • United States District Courts. 2nd Circuit. United States District Courts. 2nd Circuit. Southern District of New York
    • October 11, 1995
    ...in making these determinations, a carrier may take into account additional factors that it deems necessary to its evaluation. 42 C.F.R. § 405.502(a)(7). If a carrier finds that the claim meets all coverage criteria, it pays enrollee's benefits from federal funds according to Medicare guidel......
  • NAT. ASS'N OF PATIENTS ON HEMODIALYSIS AND TRANSPLANTATION, INC. v. Heckler, Civ. A. No. 83-2210.
    • United States
    • United States District Courts. United States District Court (Columbia)
    • June 11, 1984
    ...of reasonable cost reimbursement for providers and reasonable charge reimbursement for physicians and suppliers. 42 C.F.R. §§ 402(g), 405.502(e), 405.541-405.544. Under these rules, which were in effect until August 1, 1983, hospital dialysis facilities were paid 80 percent of the "rea......
  • Haygood v. De Escabedo, No. 09–0377.
    • United States
    • Supreme Court of Texas
    • January 27, 2012
    ...Gen. Laws 847, 889. 2. Tex. Civ. Prac. & Rem.Code § 41.0105. 3. 283 S.W.3d 3 (Tex.App.-Tyler 2009). 4. 42 C.F.R. § 405.501(a). 5. 42 C.F.R. § 405.502(a). 6. 42 U.S.C. § 1395cc(a)(1)–(2). 7. The record indicates that almost all of what has been paid was by insurance. 8. 283 S.W.3d at 7. ......
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2 firm's commentaries
  • HealthCare Fraud and Courtesies: What to Know Before Waiving a Copayment
    • United States
    • JD Supra United States
    • September 9, 2014
    ...42 U.S.C. § 1320a-7b(a)(1). [ii]CMS Pub. 100-04, ch. 23 § 80.8.1. See generally 42 U.S.C. § 1395u(b)(3); 42 C.F.R. § 405.502(a); 42 C.F.R. § 414.21; OIG Special Fraud Alerts, 59 Fed. Reg. 65372 (Dec. 19, [iii] 42 U.S.C. § 1320a-7b. [iv] OIG Special Fraud Alerts. See generally 42 U.S.C. § 13......
  • Medicare Authorities To Reduce Payment for Covered Items or Services Chart
    • United States
    • JD Supra United States
    • April 15, 2009
    ...proposing to permit CMS contractors to use LCA. Medicare Program Integrity Manual § 13.4 Social Security Act § 1842(b)(8) and (9) 42 C.F.R. 405.502(a)(7), (g), and (h). Social Security Act §§ 1833(t)(2)(E) (giving the agency authority to administer the pass-through statute in a manner “dete......
12 provisions

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