42 CFR § 424.44(a)(1)
May 23, 2020 4:18 pmExcept as provided in paragraphs (b) and (e) of this section, for services furnished on or after January 1, 2010,... View more
Archives
42 CFR § 422.520
May 23, 2020 4:17 pm(a) Contract between CMS and the MA organization. (1) The contract between CMS and the MA organization must provide that... View more
42 CFR § 422.113(c)(2-3)
May 23, 2020 4:16 pm(2) The MA organization – (i) Is financially responsible (consistent with Sec. 422.214) for post-stabilization care services obtained within or... View more
Medicare Managed Care Manual, Chapter 4, § 10.16
May 23, 2020 4:08 pm“…if the plan approved the furnishing of a service through an advance determination of coverage, it may not deny coverage... View more
42 CFR §422.113(c)(2)
May 23, 2020 3:39 pm(iii) Is financially responsible for post-stabilization care services obtained within or outside the MA organization that are not pre-approved by... View more
42 USC § 1395ddd (f)(2)
May 23, 2020 3:38 pm(2) Limitation on recoupment (A) In general In the case of a provider of services or supplier that is determined... View more
42 CFR §422.568(e)
May 23, 2020 3:33 pmThe notice of any denial under paragraph (d) of this section must – (1) Use approved notice language in a... View more
42 CFR §422.113(b)
May 23, 2020 3:27 pm(2) MA organization financial responsibility. The MA organization is financially responsible for emergency and urgently needed services— (i) Regardless of... View more
Veterans Health Administration
May 15, 2020 4:12 pmVHA Script – Medical Necessity – Qualified Reviewers
May 15, 2020 4:05 pmASK YOURSELF: Who denied the claim? What is the professional’s license number with the State Medical Board? Were they a... View more