Page 16 - Medicare Benefit Policy Manual

to determine the proper Medicare payment. (The assignment agreement prohibits the
physician from charging the beneficiary in these cases because the basis for denial is
failure to furnish information, not noncoverage of services.) In unassigned cases, if
the physician does not respond within 30 days, the A/B MAC (B) assumes that the
beneficiary filed the VA claim and pays secondary benefits to the beneficiary.

(c) Claim Is for Reimbursement of VA Copayment Amounts or Crediting of
Medicare Deductible

Beneficiaries must attach to the Medicare claim form a copy of VA form 10-9014
(Statement of Charges for Medical Care) showing the VA copayment amount for
authorized services, when requesting Medicare payment toward that amount or in
order to have their Part B deductible credited.

50.1.5 - Services Authorized by Indian Health Service
(Rev. 1, 10-01-03)
A3-3153.1.B, HO-260.3A.2 B.3-2309.3

The Division of Indian Health of the United States Public Health Service authorizes
private physicians and privately owned hospitals and nursing homes to provide treatment
to Indians and their dependents under contractual arrangements with the Division of
Indian Health. In the case of such contract health services to Indians and their
dependents entitled under the Indian Health Service (IHS) program and Medicare,
Medicare is the primary payer and the IHS the secondary payer.

50.2 - Items and Services Furnished by Federal Provider of Services or
Federal Agency
(Rev. 1, 10-01-03)
A3-3153.2, HO-260.3.A, B3-2309.1

Generally, Federal providers are excluded from participation in the Medicare program.
However, Federal hospitals, like other nonparticipating hospitals, may be paid for
emergency inpatient and outpatient hospital services. Additionally, payment is precluded
for items and services rendered by a federally operated nonprovider, e.g., Veterans
Administration clinics. A provider or other facility acquired by the Department of
Housing and Urban Development (DHUD) in the administration of an FHA mortgage
insurance program is not considered to be a Federal provider or agency and this exclusion
is not applicable to services furnished by such facilities. The law provides exceptions to
this exclusion which permits the following categories of Federal providers to participate
in Medicare:

• Hospitals and SNFs of Indian Health Service; and

• A Federal provider which is determined to be providing services to the public
generally as a community institution or agency. VA hospitals which have sharing
agreements with non-VA participating hospitals under which the VA hospitals