This subpart sets forth the requirements, procedures, and time limits for claiming Medicare payments. Claims must be filed in all cases except when services are furnished on a prepaid capitation basis by an MA organization, or through cost settlement with either a health maintenance organization (HMO), a competitive medical plan (CMP), or a health care prepayment plan (HCPP), or as part of a demonstration. Therefore, claims must be filed by hospitals seeking IME payment under § 412.105(g) of this chapter, and/or direct GME payment under § 413.76(c) of this chapter, and/or nursing or allied health education payment under § 413.87 of this chapter associated with inpatient services furnished on a prepaid capitation basis by an MA organization. Hospitals that must report patient data for purposes of the DSH payment adjustment under § 412.106 of this chapter for inpatient services furnished on a prepaid capitation basis by an MA organization, or through cost settlement with an HMO/CMP, or as part of a demonstration, are required to file claims by submitting no pay bills for such inpatients. Special procedures for claiming payment after the beneficiary has died and for certain bills paid by organizations are set forth in subpart E of this part.
[77 FR 53682, Aug. 31, 2012]
Notes of Decisions
Loma Linda Univ. Med. Ctr. v. Sebelius, 684 F. Supp. 2d 42 (D.D.C. 2010).
· cites it 13× “Regulations governing claims for payment under Part A are set forth at 42 C.F.R. § 424.30 et seq. These regulations begin by describing their scope, providing that “[cjlaims must be filed in all cases except when services are furnished on a prepaid capitation basis by a health…”
Cottage Health Sys. v. Sebelius, 631 F. Supp. 2d 80 (D.D.C. 2009).
· cites it 10× “Claims for payment under part A are governed by the regulations set forth at 42 C.F.R. § 424.30 et seq., which provide that “[cjlaims must be filed in all cases except when services are furnished on a prepaid capitation basis by a health maintenance organization (HMO), a…”
Hosp. of the Univ. of Pennsylvania v. Sebelius, 847 F. Supp. 2d 125 (D.D.C. 2012).
· cites it 11× “These claims are governed by the regulations set forth at 42 C.F.R. § 424.30 et seq. Among the requirements are time limits for filing claims, which are codified at 42 C.”
Connecticut State Dep't of Soc. Servs. v. Thompson, 242 F. Supp. 2d 127 (D. Conn. 2003).
“”); 42 C.F.R. § 424.30 (“Claims must be filed in all cases except when services are furnished on a prepaid capitation basis by a health maintenance organization (HMO), a competitive medical plan (CMP), or a health care prepayment plan (HCPP).”
Univ. Med. Ctr., Inc. v. Sebelius, 856 F. Supp. 2d 66 (D.D.C. 2012).
“3 Accordingly, the regulations at issue in those three cases, 42 C.F.R. § 424.30 et seq., are not implicated in the present case.”
Loma Linda Univ. Med. Ctr. v. Leavitt (D.D.C. 2010).
· cites it 13× “Regulations governing claims for payment under Part A are set forth at 42 C.F.R. § 424.30 et seq. These regulations begin by describing their scope, providing that “[c]laims must be filed in all cases except when services are furnished on a prepaid capitation basis by a health…”
Cottage Health Sys. v. Leavitt (D.D.C. 2009).
· cites it 8× “Claims for payment under part A are governed by the regulations set forth at 42 C.F.R. § 424.30 et seq., which provide that "[c]laims must be filed in all cases except when services are furnished on a prepaid capitation basis by a health maintenance organization (HMO), a…”
Bridgeport Hosp. v. Sebelius (D.D.C. 2011).
· cites it 2× “Specifically, the plaintiffs in both this case and the remanded cases argue that time limits set forth in 42 C.F.R. § 424.30 et seq. applied to their disputed claims, and the plaintiffs in both cases assert that the Secretary’s denial of their claims violated the public…”
Annotations are extracted automatically from the opinions in the
Syfert caselaw corpus and ranked by authority, recency, and
treatment. Dots show Syfertize treatment of the citing case itself.