General Rule

20.1.1 - General Rule (Rev. 82; Issued: 02-08-08; Effective: 01-01-08; Implementation: 03-10-08) Except as provided in section 20.1.2 of this chapter, Medicare Part B does not pay for any item or service that is furnished to a hospital outpatient, as defined in section 20.2, during an encounter, as defined in section 20.3, by an entity other than the hospital unless the hospital has arrangements with that entity to furnish that particular service to its patients. The arrangements must provide that Medicare payment made to the hospital that arranged for the services discharges the liability of the beneficiary or any other person to pay for those services. See the Medicare General Information, Eligibility, and Entitlement Manual, Pub.100-01, chapter 5, section 10.3 for the definition of “arrangements.” For the purposes of this section, the term “hospital” includes a Critical Access Hospital (CAH).