§ 424.126 - Payment to the hospital.  


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  • § 424.126 Payment to the hospital.

    (a) Conditions for payment. Medicare pays the hospital if it -

    (1) Has in effect an election that -

    (i) Meets the requirements set forth in § 424.104; and

    (ii) Reflects the hospital's intent to claim for all covered services furnished during a calendar year.

    (2) Claims payment in accordance with §§ 424.32 and 413.74 of this chapter; and

    (3) Submits evidence requested by CMS to establish that the services meet the requirements of this subpart.

    (b) Amount of payment. Payment is made (in accordance with § 413.74 of this chapter) on the basis of 100 percent of the hospital's customary charges, subject to the applicable deductible and coinsurance provisions set forth elsewhere in this chapter.