HI 00401.210 Under Arrangements

A provider may have others furnish certain covered items and services to its patients through arrangements under which receipt of payment by the provider for the services discharges the liability of the beneficiary or any other person to pay for the services. In permitting providers to furnish services under arrangements, it is not intended that the provider merely serves a billing mechanism for the other party. For services provided under arrangements to be covered, the provider must exercise professional responsibility over the arranged-for services.

The provider's professional supervision over arranged-for services requires application of many of the same quality controls as are applied to services furnished by salaried employees. The provider must accept the patient for treatment in accordance with its admission policies, maintain a complete and timely clinical record on the patient which includes diagnosis, medical history, physician's orders, and progress notes relating to all services received, and maintain liaison with the attending physician with regard to the progress of the patient and the need for revised orders or, in the case of home health services and outpatient physical therapy or speech pathology services, the required plan of treatment.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600401210
HI 00401.210 - Under Arrangements - 09/15/1989
Batch run: 01/27/2009
Rev:09/15/1989