CMS Pub. 100-04, ch. 1, § 30.2.2.1

to FIs

(Rev. 1, 10-01-03)

Definition of Participating From MIM 3005

Nonphysician suppliers may reassign benefits under conditions similar to those under

which physicians reassign benefits. Note, however, that when a supplier furnishes

services to patients of a participating provider (e.g., a participating hospital or SNF)

under arrangement (within the meaning of §1861(w) of the Act), the provider, not the

supplier, is reimbursed by Medicare. No reassignment is involved since the provider is

then responsible for paying subcontracting providers/suppliers under these payment

structures.

To be a participating provider under Medicare, a provider must be in compliance with

the applicable provisions of title VI of the Civil Rights Act of 1964 and must enter into

an agreement under §1866 of the Act which provides that it (1) will not charge any

individual or other person for items and services covered by the health insurance program

other than allowable charges and deductibles and coinsurance amounts; and (2) will

return any money incorrectly collected from the individual or other person on his behalf

or make such other disposition as described in §30.1 (See also §30.1 on participation

agreements).