Department of Health has not issued any specific guidance on which services may be considered covered services
, leaving practices with some uncertainty.
under the Contract are set forth in this section.
In addition to physicians and nurse practitioners, it would allow additional service providers such as respiratory therapists, occupational therapists, speech pathologists, and audiologists to provide covered services
Specified covered services
include common back office and administrative activities such as payroll, human resources, legal, etc.
Apropos the test for low margin covered services
, TEI recommends that any comparable study commissioned to comply with this regulation be valid for at least three years.
and "The economics of healthcare insurance regulations drive people toward covered services
, largely drugs and surgery, and away from alternative therapies that may be more conservative and less risky.
The OIG's chief counsel later clarified that the alert did not specifically take a position on concierge medicine but only addressed fees for covered services
and was consistent with the position previously taken by Secretary Thompson.
A defined benefit policy is needed--a standardized policy mandated to all insurers outlining covered services
, non-covered services
, patient and insurer responsibility, and maximum benefits payable in clear, easy to understand language, something akin to Truth in Lending.
The appeals court held that the attorney fee limitations of the Prison Litigation Reform Act (PLRA) did not apply to attorney fee awards that were entered after PLRA's enactment but which covered services
performed prior to its enactment.
Physicians who did not participate in Medicare were allowed 95 percent of the physician fee schedule amount for covered services
from Medicare and could charge beneficiaries up to 120 percent of the fee schedule amount in 1992 and 115 percent of the fee schedule amount in 1993.
By utilizing an explicit, detailed inquiry system, you should be able to accumulate enough data to make sound admission decisions based on covered services
and the patients' ability to pay.
By defining the benefit in terms of some percentage of the cost of covered services
the benefit percentage), leaving open bow costsharing works.