HI 00601.600 Provider Charges to Beneficiaries for Excess Costs

Official source

A provider which anticipates that its costs for items or services will exceed the applicable cost limit, and believes it is eligible to charge beneficiaries based on its excess costs, and wishes to impose such charges, may submit to its intermediary a request for validation of the specified charges. The provider’s charge to the beneficiary for an item or service may not exceed the amount by which its allowable costs (or, if less, the customary charge) for the item or service, in the second preceding cost reporting period exceeds the current applicable cost limit for such items or services. (In the case of a new provider, an estimated equivalent is calculated for the cost for the second preceding cost period.) The provider may make such charges only if the following conditions are met:

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HI 00601.600 Provider Charges to Beneficiaries for Excess Costs

Official source

A provider which anticipates that its costs for items or services will exceed the applicable cost limit, and believes it is eligible to charge beneficiaries based on its excess costs, and wishes to impose such charges, may submit to its intermediary a request for validation of the specified charges. The provider’s charge to the beneficiary for an item or service may not exceed the amount by which its allowable costs (or, if less, the customary charge) for the item or service, in the second preceding cost reporting period exceeds the current applicable cost limit for such items or services. (In the case of a new provider, an estimated equivalent is calculated for the cost for the second preceding cost period.) The provider may make such charges only if the following conditions are met: