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Printed Date: 9/22/2015
According to the Medicare Claims Processing Manual, Chapter 30, Section 40.1, providers and suppliers are responsible for knowing the rules and regulations that apply to all services billed by the provider to the Medicare program.
In accordance with regulations at 42 CFR 411.406, evidence that the provider, practitioner or other supplier did, in fact, know or should have known that Medicare would not pay for a service or item includes:
If any of the circumstances described above exists, a provider, practitioner or other supplier is held to have knowledge.
The provider is responsible to know the rules and regulations that are made available through publications from the Medicare carriers and fiscal intermediaries, which include, but are not limited to, the Medicare publications, articles and email updated published on the Palmetto GBA websites.
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Last Updated: 09/27/2018