Medicare Claims Processing Manual (Pub. 100-04), Ch. 19 § 100.9
A/B MAC (A) - CAH Outpatient - Medicare Part B - Payment
100.9 - A/B MAC (A) - CAH Outpatient - Medicare Part B - Payment
Policy
(Rev. 1040, Issued: 08-25-06, Effective: 09-11-06, Implementation: 09-11-06)
The IHS CAHs are paid for covered outpatient services based on 101 percent of an all
inclusive facility specific per visit rate that is established on a yearly basis from prior year
cost report information for both facilities electing Standard Method I and Optional
Method II billing.
For services provided in IHS CAHs, deductible and coinsurance amounts are applied by
Medicare, but are waived by the IHS. Third party payers may be billed for applicable
deductible and coinsurance amounts.
See Chapter 4, §§250.1 and 250.2 of Pub. 100-04, Medicare Claims Processing Manual,
for more information on the payment of Method I and II CAH outpatient claims.
See §§100.10 and 100.11 of this chapter, for more information on the payment of
vaccines and their administration and therapeutic services.