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Section 1 Introduction
- Introduction
- Federal Government Administration
- Fundamentals of Medicare: State Responsibilities
- Fundamentals of Medicare: Participating Providers
- Voluntary and Involuntary Termination of Provider Agreement
- Disclosure of Health Insurance Information
- Privacy Act
- National Provider Identifier
- Legacy Provider Numbers/Provider Transaction Access Numbers (PTANs)
- Medicare Administrative Contractors
- Fundamentals of Medicare: Information References
- Acronyms
- Fundamentals of Medicare: Glossary of Terms
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Section 2 Medicare Basics
- The History of Medicare
- What Is the Medicare Program and How Is It Funded?
- Medicare Eligibility and Premiums
- The Social Security Administration and Medicare Enrollment
- The Medicare Card
- Medicare Part A
- Inpatient Hospital Care
- Skilled Nursing Facility Inpatient Care
- Home Health Care Benefit
- The Hospice Benefit
- Medicare Part B Medical Insurance
- Fundamentals of Medicare - Medicare Program Exclusions
- Medicare Advantage Organizations
- Medicare Secondary Payer
- Supplemental Insurance
- Coordination of Benefits Trading Partners
- Section 3 Fraud and Abuse
- Section 4 Getting Ready to Bill Medicare
Section 1: Introduction
Participating Providers
Providers receiving Medicare reimbursement are known as “participating providers.” To become a participating provider, a provider must be in compliance with applicable provisions of Title VI of the Civil Rights Act of 1964 (refer to CMS IOM, Publication 100-01, Medicare General Information, Eligibility and Entitlement Manual, Chapter 1, Section 20.2).
A complete list of these provisions can be found on Justice.gov. A few of these provisions are:
- The provider will not provide any disposition, service, financial aid, or benefit to an individual that is different, or is provided in a different manner, from that provided to others under the program.
- The provider will not treat an individual differently from others in determining whether he/she satisfies any admission, enrollment, quota, eligibility, membership, or other requirement or condition which individuals must meet in order to be provided any disposition, service, financial aid, function or benefit provided under the program.
- The provider will not charge any individual or other person for items and services covered by the health insurance program, other than allowable charges and deductibles and coinsurance amounts. A provider agrees that it will return any money incorrectly collected from the individual or other person on his/her behalf.
- The provider agrees to provide Medicare beneficiaries with services ordinarily furnished by the hospital to its non-Medicare patients. A hospital may have restrictions on the types of services it provides; however, these restrictions should apply to all patients not just Medicare patients.
Reviewed 6/4/2024