e-CFR data is current as of January 23, 2020
TITLE 42—Public Health
CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) SUBCHAPTER B—MEDICARE PROGRAM (CONTINUED) PART 424—CONDITIONS FOR MEDICARE PAYMENT
Subpart A—GENERAL PROVISIONS
Subpart B—CERTIFICATION AND PLAN REQUIREMENTS
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| Requirements for inpatient services of hospitals other than inpatient psychiatric facilities. |
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| Requirements for inpatient services of inpatient psychiatric facilities. |
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| Requirements for inpatient CAH services. |
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| Timing of certification for individual admitted to a hospital before entitlement to Medicare benefits. |
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| Requirements for posthospital SNF care. |
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| Requirements for home health services. |
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| Requirements for medical and other health services furnished by providers under Medicare Part B. |
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| Requirements for comprehensive outpatient rehabilitation facility (CORF) services. |
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Subpart C—CLAIMS FOR PAYMENT
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| Basic requirements for all claims. |
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| Additional requirements: Claims for services of providers and claims by suppliers and nonparticipating hospitals. |
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| Additional requirements: Beneficiary's claim for direct payment. |
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| Evidence of authority to sign on behalf of the beneficiary. |
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| Request for payment effective for more than one claim. |
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| Time limits for filing claims. |
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Subpart D—TO WHOM PAYMENT IS ORDINARILY MADE
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| Payment to a nonparticipating hospital. |
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| Payment to the beneficiary. |
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| Payment to the beneficiary's legal guardian or representative payee. |
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| Payment to a beneficiary and to a supplier. |
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| Special payment rules for items furnished by DMEPOS suppliers and issuance of DMEPOS supplier billing privileges. |
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Subpart E—TO WHOM PAYMENT IS MADE IN SPECIAL SITUATIONS
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| Payment after beneficiary's death: Bill has been paid. |
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| Payment after beneficiary's death: Bill has not been paid. |
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| Payment to entities that provide coverage complementary to Medicare Part B. |
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| Enrollment requirements for opioid treatment programs (OTP). |
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Subpart F—LIMITATIONS ON ASSIGNMENT AND REASSIGNMENT OF CLAIMS
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| Prohibition of assignment of claims by providers. |
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| Termination of provider agreement. |
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| Prohibition of reassignment of claims by suppliers. |
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| Revocation of right to receive assigned benefits. |
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| Hearings on revocation of right to receive assigned benefits. |
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| Final determination on revocation of right to receive assigned benefits. |
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| Prohibition of assignment of claims by beneficiaries. |
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| Court ordered assignments: Conditions and limitations. |
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Subpart G—SPECIAL CONDITIONS: EMERGENCY SERVICES FURNISHED BY A NONPARTICIPATING HOSPITAL
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| Situations that do not constitute an emergency. |
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| Conditions for payment for emergency services. |
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| Election to claim payment for emergency services furnished during a calendar year. |
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| Criteria for determining whether the hospital was the most accessible. |
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| Payment to the beneficiary. |
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Subpart H—SPECIAL CONDITIONS: SERVICES FURNISHED IN A FOREIGN COUNTRY
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| Conditions for payment for emergency inpatient hospital services. |
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| Conditions for payment for nonemergency inpatient services furnished by a hospital closer to the individual's residence. |
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| Conditions for payment for physician services and ambulance services. |
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| Payment to the beneficiary. |
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Subpart I—REQUIREMENTS FOR MEDICARE DIABETES PREVENTION PROGRAM SUPPLIERS AND BENEFICIARY ENGAGEMENT INCENTIVES UNDER THE MEDICARE DIABETES PREVENTION PROGRAM EXPANDED MODEL
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| Requirements for Medicare Diabetes Prevention Program suppliers. |
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| Beneficiary engagement incentives under the Medicare Diabetes Prevention Program expanded model. |
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Subparts J-L [Reserved]
Subpart M—REPLACEMENT AND RECLAMATION OF MEDICARE PAYMENTS
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| Replacement of checks that are lost, stolen, defaced, mutilated, destroyed, or paid on forged endorsements. |
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| Intermediary and carrier checks that are lost, stolen, defaced, mutilated, destroyed or paid on forged endorsements. |
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Subparts N-O [Reserved]
Subpart P—REQUIREMENTS FOR ESTABLISHING AND MAINTAINING MEDICARE BILLING PRIVILEGES
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| Basic enrollment requirement. |
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| National Provider Identifier (NPI) on all enrollment applications and claims. |
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| Ordering covered items and services for Medicare beneficiaries. |
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| Requirements for enrolling in the Medicare program. |
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| Requirements for reporting changes and updates to, and the periodic revalidation of Medicare enrollment information. |
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| Additional provider and supplier requirements for enrolling and maintaining active enrollment status in the Medicare program. |
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| Screening levels for Medicare providers and suppliers. |
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| Disclosure of affiliations. |
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| Effective date of Medicare billing privileges. |
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| Request for payment by physicians, non-physician practitioners, physician and non-physician organizations, ambulance suppliers, and opioid treatment programs. |
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| Rejection of a provider or supplier's enrollment application for Medicare enrollment. |
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| Denial of enrollment in the Medicare program. |
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| Revocation of enrollment in the Medicare program. |
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| Deactivation of Medicare billing privileges. |
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| Provider and supplier appeal rights. |
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| Prohibitions on the sale or transfer of billing privileges. |
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| Moratoria on newly enrolling Medicare providers and suppliers. |
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