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医疗保险计划;耐用医疗设备、假肢、矫形器及用品(DMEPOS)索赔的承保机构管辖权以及涉及供应商的其他问题,以及评估地区DMEPOS承保机构的标准和准则——医疗保健财务管理局。有意见征求期的最终规则。

Medicare program; carrier jurisdiction for claims for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) and other issues involving suppliers, and criteria and standards for evaluating regional DMEPOS carriers--HCFA. Final rule with comment period.

出版信息

Fed Regist. 1992 Jun 18;57(118):27290-308.

PMID:10171046
Abstract

This final rule Modifies regulations to provide that claims for durable medical equipment, prosthetics, orthotics and certain other items covered under part B of Medicare be processed by designated carriers. Specifies the jurisdictions each designated carrier will serve. Changes the method by which claims for these items are allocated among the carriers from "point of sale" to "beneficiary residence." Establishes certain minimum standards for suppliers for purposes of submitting the above claims. Incorporates in regulations certain supplier disclosure requirements imposed under section 4164 of the Omnibus Budget Reconciliation Act of 1990, as part of the process for issuing and renewing a supplier's billing number. Describes the criteria and standards to be used beginning October 1, 1993 for evaluating the performance of designated carriers processing claims for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) in the administration of the Medicare program. Section 1842(b)(2) of the Social Security Act requires us to publish criteria and standards against which we evaluate Medicare carriers for public comment in the Federal Register. We expect the above changes to lead to more efficient and economical administration of the Medicare program.

摘要

本最终规则修改了相关规定,以规定医疗保险B部分涵盖的耐用医疗设备、假肢、矫形器及某些其他项目的索赔由指定承运人处理。明确了各指定承运人服务的辖区。将这些项目索赔在承运人之间的分配方式从“销售点”改为“受益人居所”。为供应商提交上述索赔规定了某些最低标准。将1990年《综合预算协调法》第4164节规定的某些供应商披露要求纳入法规,作为发放和更新供应商计费号码流程的一部分。描述了自1993年10月1日起用于评估指定承运人在医疗保险计划管理中处理耐用医疗设备、假肢、矫形器及用品(DMEPOS)索赔表现的标准。《社会保障法》第1842(b)(2)条要求我们公布用于评估医疗保险承运人的标准,以便在《联邦公报》上征求公众意见。我们预计上述变化将使医疗保险计划的管理更加高效和经济。

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