42 CFR 405.502 - Criteria for determining reasonable charges
| Cite as | 42 CFR 405.502 |
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39 practice notes
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Introduction to Regulatory Plan and Unified Agenda of Federal Regulatory and Deregulatory Actions, 64075-64305 [05-21048]
...(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 ......
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Nmc Homecare, Inc. v. Shalala, Civil Action No. 3:cv-95-1922.
...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......
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Walsh v. McGee, No. 89 Civ. 1310 (DNE).
...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......
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NAT. ASS'N OF PATIENTS ON HEMODIALYSIS AND TRANSPLANTATION, INC. v. Heckler, Civ. A. No. 83-2210.
...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
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Nmc Homecare, Inc. v. Shalala, Civil Action No. 3:cv-95-1922.
...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......
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Walsh v. McGee, No. 89 Civ. 1310 (DNE).
...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......
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NAT. ASS'N OF PATIENTS ON HEMODIALYSIS AND TRANSPLANTATION, INC. v. Heckler, Civ. A. No. 83-2210.
...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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Haygood v. De Escabedo, No. 09–0377.
...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
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HealthCare Fraud and Courtesies: What to Know Before Waiving a Copayment
...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......
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Medicare Authorities To Reduce Payment for Covered Items or Services Chart
...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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Introduction to Regulatory Plan and Unified Agenda of Federal Regulatory and Deregulatory Actions, 64075-64305 [05-21048]
...(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 ......
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Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
...the first comprehensive revisions to the ESRD Conditions for Coverage (CfCs) since they were adopted in 1976. The original ESRD CfCs at 42 CFR Part 405 Subpart U were deleted and new conditions were issued at 42 CFR Part 494. Subpart U now only addresses certain requirements for ESRD As a p......
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Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) and Fee Schedule Amounts, and Technical Amendments To Correct Existing Regulations Related to the CBP for Certain DMEPOS
...average payments made previously under the reasonable charge payment methodology. The criteria for determining reasonable charges are at 42 CFR 405.502. For example, the exclusive payment rule at sections 1834(a)(2), (3), (8), and (9) of the Act mandates that the fee schedule amounts for DM......
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Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) and Fee Schedule Amounts, and Technical Amendments To Correct Existing Regulations Related to the CBP for Certain DMEPOS
...which establishes a fee schedule amount. The commenters recommended the item be paid based on the reasonable charge payment method (42 CFR 405.502). The commenters recommended the item be paid under reasonable charge method as use of the item's functions may change based on the beneficiary'......
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