100-04 Medicare Claims Processing Manual: Chapter 30 Crosswalk

Medicare Claims Processing Manual
Chapter 30 - Financial Liability Protections
New
Chap.
New
Sect.
Int.
Pub. 13
Carrier
Pub. 14
PMs 	Other 	Description
30 	10 	Financial Liability Protections (FLP) Provisions of
Title XVIII
30 	20 	A3-3431 	B3-7300.1 	Limitation On Liability (LOL) Under §1879 Where
Medicare Claims Are Disallowed
30 	20.1 - 20.1.3 	B3-7300.2,
B3-7300.3
CMS Rulings: 	Coverage Denials to Which the Limitation on
Liability Applies	95-1,
96-2,
96-3,
97-1
30 	20.2 - 20.2.2 	PM AB-02-168
Part I
CMS Ruling 95-1, 	Denials for Which the Limitation On Liability
Provision Does Not Apply
30 	30 	A3-3432 	B3-7300.4 	Determining Liability for Disallowed Claims Under
§1879
30 	30.1 - 30.1.2 	A3-3432.1 	PM AB-02-168 	Determining Beneficiary’s Liability
30 	30.2 - 30.2.3 	A3-3432.2 	CMS Ruling 95-1 	Determining Provider, Practitioner, or Supplier
Liability

New
Chap.
New
Sect.
Int.
Pub. 13
Carrier
Pub. 14
PMs 	Other 	Description
30 	40 	A3-3432.1 	PM AB-02-168 	CMS Ruling 95-1 	Determining Knowledge for FLP Purposes
30 	40.1 - 40.1.4 	A3-3439,
A3-3440
CMS Ruling 95-1 	Determining Whether Provider, Practitioner, or
Supplier Had Knowledge of Noncoverage of Services
30 	40.2 - 40.2.4 	A3-3439.1 	B3-7300.5 	CMS Ruling 95-1 	Determining Whether Beneficiary Had Knowledge of
Noncoverage of Services
30 	40.3 - 40.3.8 	PM AB-02-168 	Advance Beneficiary Notice Standards
30 	50 - 50.1.4 	PM AB-02-168 Part I Form CMS-R-131 Advance Beneficiary Notice
(ABN)
30 	50.2 - 50.2.6 	When and to Whom an ABN Should Be Given
30 	50.3 - 50.3.5 	Delivery of the ABN
30 	50.4 	Choosing the ABN Form to Use
30 	50.5 	Form Instructions for ABN-G and ABN-L (Form
CMS-R-131)
30 	50.6 	Signature Requirements
30 	50.7 - 50.7.7 	Special Rules
30 	50.8 - 50.8.3 	PM AB-02-168,
Part III
Instructions for Fiscal Intermediaries and Providers on
Advance Beneficiary Notice (ABN) Standards for
Items and Services for Which Institutional Part B
Claims Will Be Processed by Fiscal Intermediaries
and on Limits on Beneficiary Liability for Medical
Equipment and Supplies

New
Chap.
New
Sect.
Int.
Pub. 13
Carrier
Pub. 14
PMs 	Other 	Description
30 	50.9 - 50.9.3 	PM AB-02-168,
Part IV
Instructions for Regional Home Health Intermediaries
(RHHIs) and Hospices on Advance Beneficiary
Notice (ABN) Standards for Certain Hospice Claims
30 	60 	PM A-03-024,
PM A-03-025
Form CMS-R-296 Home Health Advance Beneficiary
Notice (HHABN)
30 	60.1 - 60.1.4 	Basic Requirements for HHABNs
30 	60.2 - 60.2.5 	When and to Whom an HHABN Should Be Given
30 	60.3 - 60.3.5 	Delivery of HHABNs
30 	60.4 - 60.4.4 	Form Instructions for the HHABN (Form
CMS-R-296)
30 	60.5 	Signature Requirements for HHABN
30 	60.6 - 60.6.9.4 	Special Rules for HHABNs
30 	70 - 70.1.3 	A3-3730.1 	Form CMS-10055 Skilled Nursing Facility Advance
Beneficiary Notice (SNFABN)
30 	70.2 - 70.2.5 	When and to Whom a SNFABN Should Be Given
30 	70.3 - 70.3.5 	Delivery of SNFABNs
(Section heading only)
30 	70.4 - 70.4.5 	Form Instructions for the SNFABN (Form
CMS-10055)
30 	70.5 	Signature Requirements for SNFABN
30 	70.6 - 70.6.9.4 	Special Rules for SNFABNs
(Section heading only)

New
Chap.
New
Sect.
Int.
Pub. 13
Carrier
Pub. 14
PMs 	Other 	Description
30 	80 	Hospital ABNs (Hospital-Issued Notices of
Noncoverage - HINN)
30 	80.1 - 80.1.6 	When and to Whom a Hospital ABN Should Be
Given
30 	80.2 	Issuing the Appropriate Hospital ABN
30 	80.3 - 80.3.6 	Hospital ABNs (HINNs)
30 	80.4 - 80.4.3 	Signature Requirements
30 	80.5 	QIO Review Authority for Hospital ABNs
30 	80.6 - 80.6.2 	QIO Monitoring of Hospital ABNs
30 	80.7 	Notices in Investigational/Experimental Procedures
Situations
30 	80.8 - 80.8.4 	Beneficiary Liability
30 	80.9 	Provider Liability
30 	80.10 - 80.10.1 	Right to a Reconsideration
30 	90 - 90.5 	Form CMS-20007 - Notices of Exclusions From
Medicare Benefits (NEMBs)
30 	100 	A3-3446 	B3-7320 	Indemnification Procedures for Claims Falling Within
the Limitation on Liability Provision
30 	100.1 	A3-3446.1 	B3-7320.1 	Contractor and Social Security Office (SSO)
Responsibility in Indemnification Claims
30 	100.2 	A3-3446.2 	B3-7320.23,
B3-7300.5
Conditions for Indemnification

New
Chap.
New
Sect.
Int.
Pub. 13
Carrier
Pub. 14
PMs 	Other 	Description
30 	100.3 	A3-3446.3 	B3-7320.3 	Development and Documentation of Indemnification
Requests
30 	100.4 	A3-3446.4 	B3-7320.4 	Beneficiary Requests Indemnification, but Had No
Financial Interest in the Claim
30 	100.5 	A3-3446.5 	B3-7320.5 	Questionable Indemnification Requests Procedure
30 	100.6 	A3-3446.6 	B3-7320.6 	Determining the Amount of Indemnification
30 	100.7 	A3-3446.7 	B3-7320.7 	Notifying the Provider, Practitioner, or Supplier
30 	100.8 	A3-3446.8 	B3-7320.8 	Making Payment Under Indemnification
30 	100.9 	B3-7300.9 	Limitation on Liability Determination Does Not
Affect Medicare Exclusion
30 	100.10 	A3-3446.9 	B3-7320.10 	Exhibits
30 	110 	Contractor Instructions for Application of Limitation
On Liability
(Section heading only)
30 	110.1 	A3-3441 	Payment Under Limitation on Liability
30 	110.2 	A3-3442 	When to Make Limitation on Liability Decisions
30 	110.3 	A3-3443 	Preparation of Denial Notices
30 	110.4 	A3-3445 	Bill Processing
30 	120 	B3-7300,
B3-7320.10
Carrier Specific Instructions for Application of
Limitation on Liability
(Section heading only)

New
Chap.
New
Sect.
Int.
Pub. 13
Carrier
Pub. 14
PMs 	Other 	Description
30 	120.1 	B3-7300.6 	Documentation of Notices Regarding Coverage
30 	120.2 	B3-7300.7 	Availability of Coverage Notices to Operating
Personnel
30 	120.3 	B3-7300.10 	Applicability of Limitation on Liability Provision to
Claims for Outpatient Physical Therapy Services
Furnished by Clinics
30 	120.4 	B3-7300.4 	Limitation on Liability Notices to Beneficiaries from
Carriers
30 	120.5 	B3-7300.4B2 	Carrier Reviews in Assignment Cases Conducted at
the Request of Either the Beneficiary or the Assignee
30 	120.5.1 	B3-7300.4C 	Guide Paragraphs for Carriers to Use Where §1879 Is
Applicable at Review Level
30 	130 	Intermediary Specific Instructions for Application of
Limitation on Liability
30 	130.1 	A3-3444 	Applicability of the Limitation on Liability Provision
to Claims for Ancillary, Outpatient Provider and Rural
Health Clinic Services Payable Under Part B
30 	130.1.1 	A3-3444.1 	Determining Beneficiary Liability in Claims for
Ancillary and Outpatient Services
30 	130.1.2 	A3-3444.2 	Determining Provider Liability in Claims for
Ancillary and Outpatient Services
30 	130.2 	A3-3431.1 	Prior Hospitalization and Transfer Requirements for
SNF Coverage as Related to Limitation on Liability

New
Chap.
New
Sect.
Int.
Pub. 13
Carrier
Pub. 14
PMs 	Other 	Description
30 	130.3 	A3-3431.2 	Application of Limitation on Liability to SNF and
Hospital Claims for Services Furnished in
Noncertified or Inappropriately Certified Beds
30 	130.4 	A3-3431.3 	Determining Liability for Services Furnished in a
Noncertified SNF or Hospital Bed
30 	140 - 140.12 	B3-7330 	Physician Refund Requirements (RR) Provision for
Nonassigned Claims for Physicians Services Under
§1842(l) - Instructions for Carriers and Physicians
30 	150 - 150.15 	AB-02-168 Part I 	DMEPOS Refund Requirements (RR) Provision for
Claims for Medical Equipment and Supplies under
§§1834(a)(18), 1834(j)(4), and 1879(h) - Instructions
for Carriers and Suppliers