[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR415.160]



[Page 799]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 415_SERVICES FURNISHED BY PHYSICIANS IN PROVIDERS, SUPERVISING 

PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS

--Table of Contents

 

            Subpart D_Physician Services in Teaching Settings

 

Sec. 415.160  Election of reasonable cost payment for direct medical and 

surgical services of physicians in teaching hospitals: General provisions.



    (a) Scope. A teaching hospital may elect to receive payment on a 

reasonable cost basis for the direct medical and surgical services of 

its physicians in lieu of fee schedule payments that might otherwise be 

made for these services.

    (b) Conditions. A teaching hospital may elect to receive these 

payments only if--

    (1) The hospital notifies its intermediary in writing of the 

election and meets the conditions of either paragraph (b)(2) or 

paragraph (b)(3) of this section;

    (2) All physicians who furnish services to Medicare beneficiaries in 

the hospital agree not to bill charges for these services; or

    (3) All physicians who furnish services to Medicare beneficiaries in 

the hospital are employees of the hospital and, as a condition of 

employment, are precluded from billing for these services.

    (c) Effect of election. If a teaching hospital elects to receive 

reasonable cost payment for physician direct medical and surgical 

services furnished to beneficiaries--

    (1) Those services and the supervision of interns and residents 

furnishing care to individual beneficiaries are covered as hospital 

services, and

    (2) The intermediary pays the hospital for those services on a 

reasonable cost basis under the rules in Sec. 415.162. (Payment for 

other physician compensation costs related to approved GME programs is 

made as described in Sec. 413.78 of this chapter.)

    (d) Election declined. If the teaching hospital does not make this 

election, payment is made--

    (1) For physician services furnished to beneficiaries on a fee 

schedule basis as described in part 414 subject to the rules in this 

subpart, and

    (2) For the supervision of interns and residents as described in 

Sec. Sec. 413.75 through 413.83.



[60 FR 63178, Dec. 8, 1995, as amended at 70 FR 47490, Aug. 12, 2005]