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- 42 CFR 424.103 · Conditions for payment for emergency services.
- 42 CFR 424.104 · Election to claim payment for emergency services furnished during a calendar year.
- 42 CFR 424.106 · Criteria for determining whether the hospital was the most accessible.
- 42 CFR 424.108 · Payment to a hospital.
- 42 CFR 424.109 · Payment to the beneficiary.
- 42 CFR 424.120 · Scope.
- 42 CFR 424.121 · Scope of payments.
- 42 CFR 424.122 · Conditions for payment for emergency inpatient hospital services.
- 42 CFR 424.123 · Conditions for payment for nonemergency inpatient services furnished by a hospital closer to the individual's residence.
- 42 CFR 424.124 · Conditions for payment for physician services and ambulance services.
- 42 CFR 424.126 · Payment to the hospital.
- 42 CFR 424.127 · Payment to the beneficiary.
- 42 CFR 424.200 · Scope.
- 42 CFR 424.205 · Requirements for Medicare Diabetes Prevention Program suppliers.
- 42 CFR 424.210 · Beneficiary engagement incentives under the Medicare Diabetes Prevention Program expanded model.
- 42 CFR 424.350 · Replacement of checks that are lost, stolen, defaced, mutilated, destroyed, or paid on forged endorsements.
- 42 CFR 424.352 · Intermediary and carrier checks that are lost, stolen, defaced, mutilated, destroyed or paid on forged endorsements.
- 42 CFR 424.500 · Scope.
- 42 CFR 424.502 · Definitions.
- 42 CFR 424.505 · Basic enrollment requirement.
- 42 CFR 424.506 · National Provider Identifier (NPI) on all enrollment applications and claims.
- 42 CFR 424.507 · Ordering covered items and services for Medicare beneficiaries.
- 42 CFR 424.510 · Requirements for enrolling in the Medicare program.
- 42 CFR 424.514 · Application fee.
- 42 CFR 424.515 · Requirements for reporting changes and updates to, and the periodic revalidation of Medicare enrollment information.
- 42 CFR 424.516 · Additional provider and supplier requirements for enrolling and maintaining active enrollment status in the Medicare program.
- 42 CFR 424.517 · Onsite review.
- 42 CFR 424.518 · Screening levels for Medicare providers and suppliers.
- 42 CFR 424.519 · Disclosure of affiliations.
- 42 CFR 424.520 · Effective date of Medicare billing privileges.
- 42 CFR 424.521 · Request for payment by certain provider and supplier types.
- 42 CFR 424.522 · Additional effective dates.
- 42 CFR 424.525 · Rejection of a provider's or supplier's application for Medicare enrollment.
- 42 CFR 424.526 · Return of a provider's or supplier's enrollment application.
- 42 CFR 424.527 · Provisional period of enhanced oversight.
- 42 CFR 424.530 · Denial of enrollment in the Medicare program.
- 42 CFR 424.535 · Revocation of enrollment in the Medicare program.
- 42 CFR 424.540 · Deactivation of Medicare billing privileges.
- 42 CFR 424.541 · Stay of enrollment.
- 42 CFR 424.542 · Prohibition on ordering, certifying, referring, or prescribing based on felony conviction.
- 42 CFR 424.545 · Provider and supplier appeal rights.
- 42 CFR 424.546 · Deactivation rebuttals.
- 42 CFR 424.547 · Deactivation based on ordering, certifying, or referring services and items.
- 42 CFR 424.550 · Prohibitions on the sale or transfer of billing privileges.
- 42 CFR 424.551 · DMEPOS supplier changes in majority ownership.
- 42 CFR 424.555 · Payment liability.
- 42 CFR 424.565 · Overpayment.
- 42 CFR 424.570 · Moratoria on newly enrolling Medicare providers and suppliers.
- 42 CFR 424.575 · Rural emergency hospitals.
- 42 CFR 425.10 · Basis and scope.
- 42 CFR 425.20 · Definitions.
- 42 CFR 425.100 · General.
- 42 CFR 425.102 · Eligible providers and suppliers.
- 42 CFR 425.104 · Legal entity.
- 42 CFR 425.106 · Shared governance.
- 42 CFR 425.108 · Leadership and management.
- 42 CFR 425.110 · Number of ACO professionals and beneficiaries.
- 42 CFR 425.112 · Required processes and patient-centeredness criteria.
- 42 CFR 425.114 · Participation in other shared savings initiatives.
- 42 CFR 425.116 · Agreements with ACO participants and ACO providers/suppliers.
- 42 CFR 425.118 · Required reporting of ACO participants and ACO providers/suppliers.
- 42 CFR 425.200 · Participation agreement with CMS.
- 42 CFR 425.202 · Application procedures.
- 42 CFR 425.204 · Content of the application.
- 42 CFR 425.206 · Evaluation procedures for applications.
- 42 CFR 425.208 · Provisions of participation agreement.
- 42 CFR 425.210 · Application of agreement to ACO participants, ACO providers/suppliers, and others.
- 42 CFR 425.212 · Changes to program requirements during the agreement period.
- 42 CFR 425.214 · Managing changes to the ACO during the agreement period.
- 42 CFR 425.216 · Actions prior to termination.
- 42 CFR 425.218 · Termination of the participation agreement by CMS.
- 42 CFR 425.220 · Termination of the participation agreement by the ACO.
- 42 CFR 425.221 · Close-out procedures and payment consequences of early termination.
- 42 CFR 425.222 · Eligibility to re-enter the program for agreement periods beginning before July 1, 2019.
- 42 CFR 425.224 · Application procedures for renewing ACOs and re-entering ACOs.
- 42 CFR 425.226 · Annual participation elections.
- 42 CFR 425.300 · Compliance plan.
- 42 CFR 425.302 · Program requirements for data submission and certifications.
- 42 CFR 425.304 · Beneficiary incentives.
- 42 CFR 425.305 · Other program safeguards.
- 42 CFR 425.306 · Participant agreement and exclusivity of ACO participants.
- 42 CFR 425.308 · Public reporting and transparency.
- 42 CFR 425.310 · Marketing requirements.
- 42 CFR 425.312 · Beneficiary notifications.
- 42 CFR 425.314 · Audits and record retention.
- 42 CFR 425.315 · Reopening determinations of ACO shared savings or shared losses to correct financial reconciliation calculations.
- 42 CFR 425.316 · Monitoring of ACOs.
- 42 CFR 425.400 · General.
- 42 CFR 425.401 · Criteria for a beneficiary to be assigned to an ACO.
- 42 CFR 425.402 · Basic assignment methodology.
- 42 CFR 425.404 · Special assignment conditions for ACOs including FQHCs and RHCs.
- 42 CFR 425.500 · Measures to assess the quality of care furnished by an ACO for performance years (or a performance period) beginning on or before January 1, 2020.
- 42 CFR 425.502 · Calculating the ACO quality performance score for performance years (or a performance period) beginning on or before January 1, 2020.
- 42 CFR 425.504 · Incorporating reporting requirements related to the Physician Quality Reporting System Incentive and Payment Adjustment.
- 42 CFR 425.506 · Incorporating reporting requirements related to adoption of certified electronic health record technology.
- 42 CFR 425.507 · Incorporating Promoting Interoperability requirements related to the Quality Payment Program for performance years beginning on or after January 1, 2025.
- 42 CFR 425.508 · Incorporating quality reporting requirements related to the Quality Payment Program.
- 42 CFR 425.510 · Application of the APM Performance Pathway (APP) quality measure set or the APP Plus quality measure set (as applicable) to Shared Savings Program ACOs for performance years beginning on or after January 1, 2021.
- 42 CFR 425.512 · Determining the ACO quality performance standard for performance years beginning on or after January 1, 2021.
- 42 CFR 425.600 · Selection of risk model.