Conditions of and Limitations on Payment for Services[1]
Payments for furnished inpatient services may only be made to eligible providers (under Social Security Act §1866) if a provider1 certifies, as appropriate,2 the beneficiary’s need for post-hospital extended care services in a skilled nursing facility.3 Providers must periodically provide recertification supporting material in accordance with regulations.4
Footnotes
- 1. a. b. Provider = a physician, or for (B) services, a physician, an NP, a clinical nurse specialist or a PA who does not have a direct/indirect employment relationship with the facility but is working in collaboration with a physician
- 2. Social Security Act § 1814(a), 42 U.S.C. 1395f(a).
- 3. Social Security Act § 1814(a)(2)(B), 42 U.S.C. 1395f(a)(2)(B).
- 4. Social Security Act § 1814(a), 42 U.S.C. 1395f(a).
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