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42 C.F.R. PART 424--CONDITIONS FOR MEDICARE PAYMENT

TITLE 42--Public Health

CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES

SUBCHAPTER B--MEDICARE PROGRAM

PART 424--CONDITIONS FOR MEDICARE PAYMENT

Subpart A--GENERAL PROVISIONS

�424.1

Basis and scope.

�424.3

Definitions.

�424.5

Basic conditions.

�424.7

General limitations.

Subpart B--CERTIFICATION AND PLAN OF TREATMENT REQUIREMENTS

�424.10

Purpose and scope.

�424.11

General procedures.

�424.13

Requirements for inpatient services of hospitals other than psychiatric hospitals.

�424.14

Requirements for inpatient services of inpatient psychiatric facilities.

�424.15

Requirements for inpatient CAH services.

�424.16

Timing of certification for individual admitted to a hospital before entitlement to Medicare benefits.

�424.20

Requirements for posthospital SNF care.

�424.22

Requirements for home health services.

�424.24

Requirements for medical and other health services furnished by providers under Medicare Part B.

�424.27

Requirements for comprehensive outpatient rehabilitation facility (CORF) services.

Subpart C--CLAIMS FOR PAYMENT

�424.30

Scope.

�424.32

Basic requirements for all claims.

�424.33

Additional requirements: Claims for services of providers and claims by suppliers and nonparticipating hospitals.

�424.34

Additional requirements: Beneficiary's claim for direct payment.

�424.36

Signature requirements.

�424.37

Evidence of authority to sign on behalf of the beneficiary.

�424.40

Request for payment effective for more than one claim.

�424.44

Time limits for filing claims.

Subpart D--TO WHOM PAYMENT IS ORDINARILY MADE

�424.50

Scope.

�424.51

Payment to the provider.

�424.52

Payment to a nonparticipating hospital.

�424.53

Payment to the beneficiary.

�424.54

Payment to the beneficiary's legal guardian or representative payee.

�424.55

Payment to the supplier.

�424.56

Payment to a beneficiary and to a supplier.

�424.57

Special payment rules for items furnished by DMEPOS suppliers and issuance of DMEPOS supplier billing privileges.

�424.58

xxx

Subpart E--TO WHOM PAYMENT IS MADE IN SPECIAL SITUATIONS

�424.60

Scope.

�424.62

Payment after beneficiary's death: Bill has been paid.

�424.64

Payment after beneficiary's death: Bill has not been paid.

�424.66

Payment to entities that provide coverage complementary to Medicare Part B.

Subpart F--LIMITATIONS ON ASSIGNMENT AND REASSIGNMENT OF CLAIMS

�424.70

Basis and scope.

�424.71

Definitions.

�424.73

Prohibition of assignment of claims by providers.

�424.74

Termination of provider agreement.

�424.80

Prohibition of reassignment of claims by suppliers.

�424.82

Revocation of right to receive assigned benefits.

�424.83

Hearings on revocation of right to receive assigned benefits.

�424.84

Final determination on revocation of right to receive assigned benefits.

�424.86

Prohibition of assignment of claims by beneficiaries.

�424.90

Court ordered assignments: Conditions and limitations.

Subpart G--SPECIAL CONDITIONS: EMERGENCY SERVICES FURNISHED BY A NONPARTICIPATING HOSPITAL

�424.100

Scope.

�424.101

Definitions.

�424.102

Situations that do not constitute an emergency.

�424.103

Conditions for payment for emergency services.

�424.104

Election to claim payment for emergency services furnished during a calendar year.

�424.106

Criteria for determining whether the hospital was the most accessible.

�424.108

Payment to a hospital.

�424.109

Payment to the beneficiary.

Subpart H--SPECIAL CONDITIONS: SERVICES FURNISHED IN A FOREIGN COUNTRY

�424.120

Scope.

�424.121

Scope of payments.

�424.122

Conditions for payment for emergency inpatient hospital services.

�424.123

Conditions for payment for nonemergency inpatient services furnished by a hospital closer to the individual's residence.

�424.124

Conditions for payment for physician services and ambulance services.

�424.126

Payment to the hospital.

�424.127

Payment to the beneficiary.

Subparts I-L--[RESERVED]

Subpart M--REPLACEMENT AND RECLAMATION OF MEDICARE PAYMENTS

�424.350

Replacement of checks that are lost, stolen, defaced, mutilated, destroyed, or paid on forged endorsements.

�424.352

Intermediary and carrier checks that are lost, stolen, defaced, mutilated, destroyed or paid on forged endorsements.

Subparts N-O--[RESERVED]

Subpart P--REQUIREMENTS FOR ESTABLISHING AND MAINTAINING MEDICARE BILLING PRIVILEGES

�424.500

Scope.

�424.502

Definitions.

�424.505

Basic enrollment requirement.

�424.510

Requirements for enrolling in the Medicare program.

�424.515

Requirements for reporting changes and updates to, and the periodic revalidation of Medicare enrollment information.

�424.520

Additional provider and supplier requirements for enrolling and maintaining active enrollment status in the Medicare program.

�424.525

Rejection of a provider or supplier's enrollment application for Medicare enrollment.

�424.530

Denial of enrollment.

�424.535

Revocation of enrollment and billing privileges in the Medicare program.

�424.540

Deactivation of Medicare billing privileges.

�424.545

Provider and supplier appeal rights.

�424.550

Prohibitions on the sale or transfer of billing privileges.

�424.555

Payment liability.