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- 42 CFR 411.101 · Definitions.
- 42 CFR 411.102 · Basic prohibitions and requirements.
- 42 CFR 411.103 · Prohibition against financial and other incentives.
- 42 CFR 411.104 · Current employment status.
- 42 CFR 411.106 · Aggregation rules.
- 42 CFR 411.108 · Taking into account entitlement to Medicare.
- 42 CFR 411.110 · Basis for determination of nonconformance.
- 42 CFR 411.112 · Documentation of conformance.
- 42 CFR 411.114 · Determination of nonconformance.
- 42 CFR 411.115 · Notice of determination of nonconformance.
- 42 CFR 411.120 · Appeals.
- 42 CFR 411.121 · Hearing procedures.
- 42 CFR 411.122 · Hearing officer's decision.
- 42 CFR 411.124 · Administrator's review of hearing decision.
- 42 CFR 411.126 · Reopening of determinations and decisions.
- 42 CFR 411.130 · Referral to Internal Revenue Service (IRS).
- 42 CFR 411.160 · Scope.
- 42 CFR 411.161 · Prohibition against taking into account Medicare eligibility or entitlement or differentiating benefits.
- 42 CFR 411.162 · Medicare benefits secondary to group health plan benefits.
- 42 CFR 411.163 · Coordination of benefits: Dual entitlement situations.
- 42 CFR 411.165 · Basis for conditional Medicare payments.
- 42 CFR 411.170 · General provisions.
- 42 CFR 411.172 · Medicare benefits secondary to group health plan benefits.
- 42 CFR 411.175 · Basis for Medicare primary payments.
- 42 CFR 411.200 · Basis.
- 42 CFR 411.201 · Definitions.
- 42 CFR 411.204 · Medicare benefits secondary to LGHP benefits.
- 42 CFR 411.206 · Basis for Medicare primary payments and limits on secondary payments.
- 42 CFR 411.350 · Scope of subpart.
- 42 CFR 411.351 · Definitions.
- 42 CFR 411.352 · Group practice.
- 42 CFR 411.353 · Prohibition on certain referrals by physicians and limitations on billing.
- 42 CFR 411.354 · Financial relationship, compensation, and ownership or investment interest.
- 42 CFR 411.355 · General exceptions to the referral prohibition related to both ownership/investment and compensation.
- 42 CFR 411.356 · Exceptions to the referral prohibition related to ownership or investment interests.
- 42 CFR 411.357 · Exceptions to the referral prohibition related to compensation arrangements.
- 42 CFR 411.361 · Reporting requirements.
- 42 CFR 411.362 · Additional requirements concerning physician ownership and investment in hospitals.
- 42 CFR 411.363 · Process for requesting an exception from the prohibition on facility expansion.
- 42 CFR 411.370 · Advisory opinions relating to physician referrals.
- 42 CFR 411.372 · Procedure for submitting a request.
- 42 CFR 411.373 · Certification.
- 42 CFR 411.375 · Fees for the cost of advisory opinions.
- 42 CFR 411.377 · Expert opinions from outside sources.
- 42 CFR 411.378 · Withdrawing a request.
- 42 CFR 411.379 · When CMS accepts a request.
- 42 CFR 411.380 · When CMS issues a formal advisory opinion.
- 42 CFR 411.382 · CMS' right to rescind advisory opinions.
- 42 CFR 411.384 · Disclosing advisory opinions and supporting information.
- 42 CFR 411.386 · CMS's advisory opinions as exclusive.
- 42 CFR 411.387 · Effect of an advisory opinion.
- 42 CFR 411.388 · When advisory opinions are not admissible evidence.
- 42 CFR 411.389 · Range of the advisory opinion.
- 42 CFR 411.400 · Payment for custodial care and services not reasonable and necessary.
- 42 CFR 411.402 · Indemnification of beneficiary.
- 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.
- 42 CFR 411.406 · Criteria for determining that a provider, practitioner, or supplier knew that services were excluded from coverage as custodial care or as not reasonable and necessary.
- 42 CFR 411.408 · Refunds of amounts collected for physician services not reasonable and necessary, payment not accepted on an assignment-related basis.
- 42 CFR 412.1 · Scope of part.
- 42 CFR 412.2 · Basis of payment.
- 42 CFR 412.3 · Admissions.
- 42 CFR 412.4 · Discharges and transfers.
- 42 CFR 412.6 · Cost reporting periods subject to the prospective payment systems.
- 42 CFR 412.8 · Publication of schedules for determining prospective payment rates.
- 42 CFR 412.10 · Changes in the DRG classification system.
- 42 CFR 412.20 · Hospital services subject to the prospective payment systems.
- 42 CFR 412.22 · Excluded hospitals and hospital units: General rules.
- 42 CFR 412.23 · Excluded hospitals: Classifications.
- 42 CFR 412.24 · Requirements under the PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) Program.
- 42 CFR 412.25 · Excluded hospital units: Common requirements.
- 42 CFR 412.27 · Excluded psychiatric units: Additional requirements.
- 42 CFR 412.29 · Classification criteria for payment under the inpatient rehabilitation facility prospective payment system.
- 42 CFR 412.30 · [Reserved]
- 42 CFR 412.40 · General requirements.
- 42 CFR 412.42 · Limitations on charges to beneficiaries.
- 42 CFR 412.44 · Medical review requirements: Admissions and quality review.
- 42 CFR 412.46 · Medical review requirements.
- 42 CFR 412.48 · Denial of payment as a result of admissions and quality review.
- 42 CFR 412.50 · Furnishing of inpatient hospital services directly or under arrangements.
- 42 CFR 412.52 · Reporting and recordkeeping requirements.
- 42 CFR 412.60 · DRG classification and weighting factors.
- 42 CFR 412.62 · Federal rates for inpatient operating costs for fiscal year 1984.
- 42 CFR 412.63 · Federal rates for inpatient operating costs for Federal fiscal years 1984 through 2004.
- 42 CFR 412.64 · Federal rates for inpatient operating costs for Federal fiscal year 2005 and subsequent fiscal years.
- 42 CFR 412.70 · General description.
- 42 CFR 412.71 · Determination of base-year inpatient operating costs.
- 42 CFR 412.72 · Modification of base-year costs.
- 42 CFR 412.73 · Determination of the hospital-specific rate based on a Federal fiscal year 1982 base period.
- 42 CFR 412.75 · Determination of the hospital-specific rate for inpatient operating costs based on a Federal fiscal year 1987 base period.
- 42 CFR 412.76 · Recovery of excess transition period payment amounts resulting from unlawful claims.
- 42 CFR 412.77 · Determination of the hospital-specific rate for inpatient operating costs for sole community hospitals based on a Federal fiscal year 1996 base period.
- 42 CFR 412.78 · Determination of the hospital-specific rate for inpatient operating costs for sole community hospitals based on a Federal fiscal year 2006 base period.
- 42 CFR 412.79 · Determination of the hospital-specific rate for inpatient operating costs for Medicare-dependent, small rural hospitals based on a Federal fiscal year 2002 base period.
- 42 CFR 412.80 · Outlier cases: General provisions.
- 42 CFR 412.82 · Payment for extended length-of-stay cases (day outliers).
- 42 CFR 412.84 · Payment for extraordinarily high-cost cases (cost outliers).
- 42 CFR 412.85 · Payment adjustment for certain immunotherapy cases.
- 42 CFR 412.83 · Payment for extraordinarily high-cost day outliers.
- 42 CFR 412.86 · 412.86 [Reserved]
- 42 CFR 412.87 · Additional payment for new medical services and technologies: General provisions.