![]() ![]() ![]() (2) To a physician or other supplier after the beneficiary's death, in accordance with § 424.64(c)(1) of this chapter or (1) To a physician or other supplier that accepts assignment from the beneficiary, in accordance with § 424.55 or § 424.56 of this chapter Payment on an assignment-related basis means payment for Part B services. Participating supplier means a supplier that has an agreement with CMS to participate in Part B of Medicare in effect on the date of the service. Nonparticipating supplier means a supplier that does not have an agreement with CMS to participate in Part B of Medicare in effect on the date of the service. An NCD does not include a determination of what code, if any, is assigned to a service or a determination with respect to the amount of payment to be made for the service. National coverage determination (NCD) means a decision that CMS makes regarding whether to cover a particular service nationally under title XVIII of the Act. Medicare Part D means the voluntary prescription drug benefit program authorized under Part D of title XVIII of the Act. Medicare Part C means the choice of Medicare benefits through Medicare Advantage plans authorized under Part C of the title XVIII of the Act. ![]() Medicare Part B means the supplementary medical insurance program authorized under Part B of title XVIII of the Act. Medicare Part A means the hospital insurance program authorized under Part A of title XVIII of the Act. Medicare integrity program contractor means an entity that has a contract with CMS under section 1893 of the Act to perform exclusively one or more of the program integrity activities specified in that section. An LCD does not include a determination of which procedure code, if any, is assigned to a service or a determination with respect to the amount of payment to be made for the service. An LCD may provide that a service is not reasonable and necessary for certain diagnoses and/or for certain diagnosis codes. Local coverage determination (LCD) means a decision by a fiscal intermediary or a carrier under Medicare Part A or Part B, as applicable, whether to cover a particular service on an intermediary-wide or carrier-wide basis in accordance with section 1862(a)(1)(A) of the Act. Intermediary means an entity that has a contract with CMS to determine and make Medicare payments for Part A or Part B benefits payable on a cost basis and to perform other related functions. Hospital insurance benefits means payments on behalf of, and in rare circumstances directly to, an entitled individual for services that are covered under Part A of title XVIII of the Act. GME stands for graduate medical education. (3) For purposes of part 426 of this chapter, a Member of the Board and, at the discretion of the Board Chair, any other Board staff appointed by the Board Chair to perform a review under that part.Įntitled means that an individual meets all the requirements for Medicare benefits.Įssential access community hospital (EACH) means a hospital designated by CMS as meeting the applicable requirements of section 1820 of the Act and of subpart G of part 412 of this chapter, as in effect on September 30, 1997. (2) For purposes of review of ALJ decisions under part 405, subparts G and H part 417, subpart Q part 422, subpart M and part 478, subpart B of this chapter, the Medicare Appeals Council designated by the Board Chair. § 400.202 Definitions specific to Medicare.Īs used in connection with the Medicare program, unless the context indicates otherwise-Ĭarrier means an entity that has a contract with CMS to determine and make Medicare payments for Part B benefits payable on a charge basis and to perform other related functions.Ĭritical access hospital (CAH) means a facility designated by HFCA as meeting the applicable requirements of section 1820 of the Act and of subpart F of part 485 of this chapter.ĭepartmental Appeals Board means: (1) Except as provided in paragraphs (2) and (3) of this definition, a Board established in the office of the Secretary, whose members act in panels to provide impartial review of disputed decisions made by operating components of the Department or by ALJs. ![]()
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