[Code of Federal Regulations] [Title 42, Volume 2] [Revised as of October 1, 2002] From the U.S. Government Printing Office via GPO Access [CITE: 42CFR400.202] [Page 6-7] TITLE 42--PUBLIC HEALTH HUMAN SERVICES PART 400--INTRODUCTION; DEFINITIONS--Table of Contents Subpart B--Definitions Sec. 400.202 Definitions specific to Medicare. As used in connection with the Medicare program, unless the context indicates otherwise-- Beneficiary means a person who is entitled to Medicare benefits. Carrier means an entity that has a contract with CMS to determine and make Medicare payments for Part B benefits payable on a charge basis and to perform other related functions. Critical access hospital (CAH) means a facility designated by HFCA as meeting the applicable requirements of section 1820 of the Act and of subpart F of part 485 of this chapter. Entitled means that an individual meets all the requirements for Medicare benefits. Essential access community hospital (EACH) means a hospital designated by CMS as meeting the applicable requirements of section 1820 of the Act and of subpart G of part 412 of this chapter, as in effect on September 30, 1997. GME stands for graduate medical education. Hospital insurance benefits means payments on behalf of, and in rare circumstances directly to, an entitled individual for services that are covered under Part A of title XVIII of the Act. Intermediary means an entity that has a contract with CMS to determine and make Medicare payments for Part A or Part B benefits payable on a cost basis and to perform other related functions. Medicare Part A means the hospital insurance program authorized under Part A of title XVIII of the Act. Medicare Part B means the supplementary medical insurance program authorized under Part B of title XVIII of the Act. [[Page 7]] National coverage determination (NCD) means a national policy determination regarding the coverage status of a particular service, that makes under section 1862(a)(1) of the Act, and publishes as a Federal Register notice or CMS Ruling. (The term does not include coverage changes mandated by statute.) Nonparticipating supplier means a supplier that does not have an agreement with CMS to participate in Part B of Medicare in effect on the date of the service. Participating supplier means a supplier that has an agreement with CMS to participate in Part B of Medicare in effect on the date of the service. Payment on an assignment-related basis means payment for Part B services-- (1) To a physician or other supplier that accepts assignment from the beneficiary, in accordance with Sec. 424.55 or Sec. 424.56 of this chapter; (2) To a physician or other supplier after the beneficiary's death, in accordance with Sec. 424.64(c)(1) of this chapter; or (3) To an entity that pays the physician or other supplier under a health benefit plan, in accordance with Sec. 424.66 of this chapter. Provider means a hospital, a CAH, a skilled nursing facility, a comprehensive outpatient rehabilitation facility, a home health agency, or a hospice that has in effect an agreement to participate in Medicare, or a clinic, a rehabilitation agency, or a public health agency that has in effect a similar agreement but only to furnish outpatient physical therapy or speech pathology services, or a community mental health center that has in effect a similar agreement but only to furnish partial hospitalization services. Railroad retirement benefits means monthly benefits payable to individuals under the Railroad Retirement Act of 1974 (45 U.S.C. beginning at section 231). Services means medical care or services and items, such as medical diagnosis and treatment, drugs and biologicals, supplies, appliances, and equipment, medical social services, and use of hospital, CAH, or SNF facilities. Supplementary medical insurance benefits means payment to or on behalf of an entitled individual for services covered under Part B of title XVIII of the Act. Supplier means a physician or other practitioner, or an entity other than a provider, that furnishes health care services under Medicare. [48 FR 12534, Mar. 25, 1983, as amended at 48 FR 56024, Dec. 16, 1983; 49 FR 3658, Jan. 30, 1984; 51 FR 43197, Dec. 1, 1986; 52 FR 27764, July 23, 1987; 55 FR 24567, June 18, 1990; 56 FR 8852, Mar. 1, 1991; 58 FR 30666, May 26, 1993; 59 FR 6576, Feb. 11, 1994; 60 FR 63175, Dec. 8, 1995; 62 FR 46025, Aug. 29, 1997; 62 FR 59098, Oct. 31, 1997; 63 FR 35065, June 26, 1998]