42 CFR 411.404 - Criteria for determining that a beneficiary knew that services were excluded from coverage as custodial care or as not reasonable and necessary
| Cite as | 42 CFR 411.404 |
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28 practice notes
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Almy v. Sebelius, Civil Action No. RDB–08–1245.
...of medical necessity. When this written notice is supplied to the beneficiary, the beneficiary is liable for payment of the DME item. 42 C.F.R. § 411.404(b); MCPM Ch. 30, § 40.1.1. In the ABN, the supplier must state the potential reason for Medicare's denial of DME payment and must also de......
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Cal. Clinical Lab. Ass'n v. Sec'y of Health & Human Servs., Civil Action No. 14–cv–0673 KBJ
...for the denied services or items[.]” Id.; see alsoInt'l Rehabilitative Scis. Inc. v. Sebelius,688 F.3d 994, 998 (9th Cir.2012)(citing 42 C.F.R. § 411.404) (explaining that Medicare providers bear the financial risk of coverage denials in absence of written advance beneficiary notices shifti......
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Townsend v. Cochran, 20-cv-01210 (ALC)
...written notice (called an "Advance Beneficiary Notice") of the specific reason why the item or service will probably not be covered. 42 C.F.R. § 411.404(b). Here, there was no evidence that Plaintiff had received an Advance Beneficiary Notice. CAR at 73.7 These decisions are all part of the......
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Townsend v. Cochran, 20-cv-01210 (ALC)
...written notice (called an "Advance Beneficiary Notice") of the specific reason why the item or service will probably not be covered. 42 C.F.R. § 411.404(b). Here, there was no evidence that Plaintiff had received an Advance Beneficiary Notice. CAR at 73. 7. These decisions are all part of t......
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17 cases
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Almy v. Sebelius, Civil Action No. RDB–08–1245.
...of medical necessity. When this written notice is supplied to the beneficiary, the beneficiary is liable for payment of the DME item. 42 C.F.R. § 411.404(b); MCPM Ch. 30, § 40.1.1. In the ABN, the supplier must state the potential reason for Medicare's denial of DME payment and must also de......
-
Cal. Clinical Lab. Ass'n v. Sec'y of Health & Human Servs., Civil Action No. 14–cv–0673 KBJ
...for the denied services or items[.]” Id.; see alsoInt'l Rehabilitative Scis. Inc. v. Sebelius,688 F.3d 994, 998 (9th Cir.2012)(citing 42 C.F.R. § 411.404) (explaining that Medicare providers bear the financial risk of coverage denials in absence of written advance beneficiary notices shifti......
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Townsend v. Cochran, 20-cv-01210 (ALC)
...written notice (called an "Advance Beneficiary Notice") of the specific reason why the item or service will probably not be covered. 42 C.F.R. § 411.404(b). Here, there was no evidence that Plaintiff had received an Advance Beneficiary Notice. CAR at 73.7 These decisions are all part of the......
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Townsend v. Cochran, 20-cv-01210 (ALC)
...written notice (called an "Advance Beneficiary Notice") of the specific reason why the item or service will probably not be covered. 42 C.F.R. § 411.404(b). Here, there was no evidence that Plaintiff had received an Advance Beneficiary Notice. CAR at 73. 7. These decisions are all part of t......
Request a trial to view additional results