45 CFR §164.530 (c)
May 23, 2020 4:26 pm(1) Standard: Safeguards. A covered entity must have in place appropriate administrative, technical, and physical safeguards to protect the privacy... View more
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42 CFR § 422.520(b)(1-2)
May 23, 2020 4:20 pm(1) Contracts between MA organizations and providers and suppliers. Contracts or other written agreements between MA organization and providers must... View more
42 CFR § 422.216(a)(3-4)
May 23, 2020 4:19 pm(3) Noncontract providers. The organization pays for services of noncontract providers in accordance with Sec. 422.100(b)(2). (4) Service furnished by... View more
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
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