US · guidance
CMS Pub. 100-08, ch. 4, § 4.10.2.5
Denial of Payment to an Excluded Party
The UPICs shall not recommend payments to the AC or MAC, and ACs and MACs shall
not make payment on any excluded individual or entity for items or services furnished,
ordered, or prescribed in any capacity on or after the effective date of exclusion, except
in the following cases:
• For inpatient hospital services or post-hospital SNF care provided to an
individual admitted to a hospital or SNF before the effective date of the
exclusion, make payment, if appropriate, for up to 30 days after that date.
• For home health services provided under a plan established before the effective
date of exclusion, make payment, if appropriate, for 30 days after the date on
the notice.
• For emergency items and services furnished, ordered, or prescribed (other than
an emergency item or service furnished, ordered, or prescribed in a hospital
emergency room) payment may be made to an excluded provider on or after
the effective date of exclusion.
History
(Rev. 11032; Issued: 09-30-21; Effective: 10-12-21; Implementation: 11-10-21)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
7a9329d9a1c151a11433ce1cbf13abf0f941fd4ccecb8c90e95d7e9d609818a9
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