Determination of amount
The Secretary shall periodically determine the amount which should be paid under this part to each provider of services with respect to the services furnished by it, and the provider of services shall be paid, at such time or times as the Secretary believes appropriate (but not less often than monthly) and prior to audit or settlement by the Government Accountability Office, from the Federal Hospital Insurance Trust Fund, the amounts so determined, with necessary adjustments on account of previously made overpayments or underpayments; except that no such payments shall be made to any provider unless it has furnished such information as the Secretary may request in order to determine the amounts due such provider under this part for the period with respect to which the amounts are being paid or any prior period.
Conditions
section 1395x(w)(2) of this titlesection 1395x(w)(2) of this titleNo payment shall be made to a provider of services which is a hospital for or with respect to services furnished by it for any period with respect to which it is deemed, under , to have in effect an arrangement with a quality improvement organization for the conduct of utilization review activities by such organization unless such hospital has paid to such organization the amount due (as determined pursuant to such section) to such organization for the review activities conducted by it pursuant to such arrangements or such hospital has provided assurances satisfactory to the Secretary that such organization will promptly be paid the amount so due to it from the proceeds of the payment claimed by the hospital. Payment under this subchapter for utilization review activities provided by a quality improvement organization pursuant to an arrangement or deemed arrangement with a hospital under shall be calculated without any requirement that the reasonable cost of such activities be apportioned among the patients of such hospital, if any, to whom such activities were not applicable.
Payments under assignment or power of attorney
No payment which may be made to a provider of services under this subchapter for any service furnished to an individual shall be made to any other person under an assignment or power of attorney; but nothing in this subsection shall be construed (1) to prevent the making of such a payment in accordance with an assignment from the provider if such assignment is made to a governmental agency or entity or is established by or pursuant to the order of a court of competent jurisdiction, or (2) to preclude an agent of the provider of services from receiving any such payment if (but only if) such agent does so pursuant to an agency agreement under which the compensation to be paid to the agent for his services for or in connection with the billing or collection of payments due such provider under this subchapter is unrelated (directly or indirectly) to the amount of such payments or the billings therefor, and is not dependent upon the actual collection of any such payment.
Accrual of interest on balance of excess or deficit not paid
section 1320b–5(g)(1)(B) of this titleWhenever a final determination is made that the amount of payment made under this part to a provider of services was in excess of or less than the amount of payment that is due, and payment of such excess or deficit is not made (or effected by offset) within 30 days of the date of the determination, interest shall accrue on the balance of such excess or deficit not paid or offset (to the extent that the balance is owed by or owing to the provider) at a rate determined in accordance with the regulations of the Secretary of the Treasury applicable to charges for late payments (or, in the case of such a determination made with respect to a payment made on or after , and during the emergency period described in under the program under subsection (e)(3), including such program as expanded pursuant to subsection (f), at a rate of 4 percent).
Periodic interim payments
Expansion of accelerated payment program during COVID–19 public health emergency
Aug. 14, 1935, ch. 531Pub. L. 89–97, title I, § 102(a)79 Stat. 297Pub. L. 94–182, title I, § 112(a)(2)89 Stat. 1055Pub. L. 95–142, § 2(a)(2)91 Stat. 1175Pub. L. 96–473, § 6(i)94 Stat. 2266Pub. L. 97–248, title I96 Stat. 354Pub. L. 99–509, title IX, § 9311(a)(1)100 Stat. 1996Pub. L. 101–239, title VI, § 6021(a)103 Stat. 2166Pub. L. 105–33, title IV, § 4603(b)111 Stat. 470Pub. L. 108–173, title IV, § 405(c)(1)117 Stat. 2266Pub. L. 108–271, § 8(b)118 Stat. 814Pub. L. 112–40, title II, § 261(a)(3)(B)125 Stat. 423Pub. L. 116–136, div. A, title III, § 3719134 Stat. 426Pub. L. 116–159, div. C, title V, § 2501(a)(1)(A)134 Stat. 733–735(, title XVIII, § 1815, as added , , ; amended , , ; , , ; , , ; , §§ 117(a)(1), 148(b), , , 394; , , ; , , ; , , ; , title VII, § 736(a)(3), , , 2354; , , ; , , ; , , ; , (B), (b)(1)(A), , .)
Editorial Notes
Amendments
Pub. L. 116–159, § 2501(b)(1)(A)section 1320b–5(g)(1)(B) of this title2020—Subsec. (d). , inserted before period at end “(or, in the case of such a determination made with respect to a payment made on or after , and during the emergency period described in under the program under subsection (e)(3), including such program as expanded pursuant to subsection (f), at a rate of 4 percent)”.
Pub. L. 116–136, § 3719(1)Subsec. (e)(3). , substituted “Subject to subsection (f), in the case” for “In the case”.
Pub. L. 116–136, § 3719(2)Subsec. (f). , added subsec. (f).
Pub. L. 116–159, § 2501(a)(1)(B)Subsec. (f)(2)(A)(ii). , which directed insertion of “(or, with respect to requests submitted to the Secretary after , may)” after “shall.”, was executed by making the insertion after “shall” to reflect the probable intent of Congress.
Pub. L. 116–159, § 2501(a)(1)(A)Subsec. (f)(2)(C). , amended subpar. (C) generally. Prior to amendment, subpar. (C) read as follows: “Upon the request of the hospital, the Secretary shall do the following:
“(i) Provide up to 120 days before claims are offset to recoup the accelerated payment.
“(ii) Allow not less than 12 months from the date of the first accelerated payment before requiring that the outstanding balance be paid in full.”
Pub. L. 112–402011—Subsec. (b). substituted “quality improvement” for “quality control and peer review” in two places.
Pub. L. 108–2712004—Subsec. (a). substituted “Government Accountability Office” for “General Accounting Office”.
Pub. L. 108–173, § 736(a)(3)2003—Subsec. (e)(1)(B). , substituted “of a hospital” for “of hospital” in introductory provisions.
Pub. L. 108–173, § 405(c)(1)(A)Subsec. (e)(2). , inserted “, in the cases described in subparagraphs (A) through (D)” after “1986” in introductory provisions.
Pub. L. 108–173, § 405(c)(1)(B)Subsec. (e)(2)(E). –(D), added subpar. (E).
Pub. L. 105–331997—Subsec. (e)(2)(C) to (E). inserted “and” at end of subpar. (C), redesignated subpar. (E) as (D), and struck out former subpar. (D) which read as follows: “home health services; and”.
Pub. L. 101–2391989—Subsec. (e)(4). added par. (4).
Pub. L. 99–5091986—Subsec. (e). added subsec. (e).
Pub. L. 97–248, § 148(b)1982—Subsec. (b). , substituted “quality control and peer review organization” for “Professional Standards Review Organization” wherever appearing.
Pub. L. 97–248, § 117(a)(1)Subsec. (d). , added subsec. (d).
Pub. L. 96–4731980—Subsec. (c). substituted “for or in connection with” for “for on in connection with”.
Pub. L. 95–1421977—Subsec. (c). added subsec. (c).
Pub. L. 94–1821975— designated existing provisions as subsec. (a) and added subsec. (b).
Statutory Notes and Related Subsidiaries
Effective Date of 2011 Amendment
Pub. L. 112–40section 261(e) of Pub. L. 112–40section 1320c of this titleAmendment by applicable to contracts entered into or renewed on or after , see , set out as a note under .
Effective Date of 2003 Amendment
Pub. L. 108–173, title IV, § 405(c)(3)117 Stat. 2267
Effective Date of 1997 Amendment
Pub. L. 105–33section 4603(d) of Pub. L. 105–33section 1395fff of this titleAmendment by applicable to cost reporting periods beginning on or after , except as otherwise provided, see , set out as an Effective Date note under .
Effective Date of 1989 Amendment
Pub. L. 101–239, title VI, § 6021(b)103 Stat. 2167
Effective Date of 1986 Amendment
Pub. L. 99–509, title IX, § 9311(a)(2)100 Stat. 1997
Effective Date of 1982 Amendment
Pub. L. 97–248, title I, § 117(b)96 Stat. 355
section 148(b) of Pub. L. 97–248section 149 of Pub. L. 97–248section 1320c of this titleAmendment by effective with respect to contracts entered into or renewed on or after , see , set out as an Effective Date note under .
Effective Date of 1977 Amendment
Pub. L. 95–142, § 2(a)(4)91 Stat. 1176
Effective Date of 1975 Amendment
Pub. L. 94–182section 112(d) of Pub. L. 94–182section 1395x of this titleAmendment by effective with respect to utilization review activities conducted on and after the first day of the first month which begins more than 30 days after , see , set out as a note under .
Application to Other Part A Providers
Pub. L. 116–159, div. C, title V, § 2501(a)(1)(C)134 Stat. 734
In general .—
Applicable program defined .—
Applicable provider .—
Pub. L. 116–159, div. C, title V, § 2501(b)(1)(B)134 Stat. 736
Publication of Data
Pub. L. 116–159, div. C, title V, § 2501(c)134 Stat. 736
Data during covid–19 emergency.—
Initial publication .—
Interim publication .—
Additional publications .—
Definitions .—
Applicable payment program .—
Emergency period .—
Provider of services and supplier .—
Secretary .—
Specified payments .—
Development of Alternative Timing Methods of Periodic Interim Payments
Pub. L. 108–173, title IV, § 405(c)(2)117 Stat. 2267
Transition
Pub. L. 99–509, title IX, § 9311(a)(3)100 Stat. 1997
Delay in Periodic Interim Payments
Pub. L. 97–248, title I, § 12096 Stat. 355
Pub. L. 96–499, title IX, § 95994 Stat. 2650Pub. L. 97–35, title XXI, § 215595 Stat. 802, , , provided for deferral of interim payments to be made during last twenty-one days of fiscal year 1981 until fiscal year 1982, prior to repeal by , , .