Medicare program; procedures for determining whether providers, practitioners, or other suppliers of services are liable for certain noncovered services--HCFA. Final rule.
These regulations revise the way we apply limitation of liability for certain noncovered services furnished by providers, practitioners, and suppliers of Medicare services under section 1879 of the Social Security Act. We will no longer apply an administrative mechanism, commonly known as the favorable presumption, in determining whether a hospital, skilled nursing facility, or home health agency should be held liable for furnishing a noncovered service. The decision to make or deny payment for these noncovered provider services will now be made after an analysis of the circumstances, without the use of a presumption as to whether the provider did not know or could not be expected to know that furnished services were noncovered.
D014487:Centers for Medicare and Medicaid Services, U.S.; D006296:Health Services / Q000191:economics*; D007345:Insurance Claim Review / Q000331:legislation & jurisprudence*; D007348:Insurance, Health / Q000331:legislation & jurisprudence*; D006278:Medicare / Q000331:legislation & jurisprudence*; D014481:United States