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Medicare program; determination of reasonable charges. Health Care Financing Administration. Interim final rule with a comment period.

This final rule implements section 946 of the Omnibus Reconciliation Act of 1980 by amending our regulations concerning the payment of reasonable charges for services furnished under Part B of the Medicare program. Section 946 specifies that payment for medical or other health care services will be determined on the basis of the customary and prevailing charge screens in effect at the time the services are furnished. (Current regulations provide that payment will be determined on the basis of the screens in effect at the time a claim is submitted or a request for payment is made.) The statute also requires that, when services are furnished more than twelve months before the fee screen year (July 1-June 30) in which the claim is submitted, payment will be based on the customary and prevailing charge screens in effect for the fee screen year immediately preceding the one in which the claim is submitted. Thus, we will not go back further than the immediately preceding fee screen year to determine reasonable charges for claims filed after long delays.