CMS Pub. 100-16, ch. mc86c17b, § 80

The following list summarizes the general topics covered in the “Provider

Reimbursement Manual” (Pub. 15). These principles will be used in determining the

reasonableness of costs incurred by HMO/CMPs by providers of services and other

facilities owned or operated by the cost-based HMO/CMP, and whether or not they are

allowable costs. Principles relating to cost apportionment and the payment process are

contained in Chapter 17 of this manual. Absent specific instructions in this manual, an

HMO/CMP should apply those principles of reimbursement of provider costs contained

in the “Provider Reimbursement Manual” (Pub. 15).

Topic Chapter Reference in

“Provider

Reimbursement

Manual,” Part I

Depreciation 1

Interest Expense 2

Bad Debts, Charity, and Courtesy Allowances 3

Cost of Educational Activities 4

Research Costs 5

Value of Services of Non-paid Workers 7

Purchase Discounts and Allowances, and Refunds of

Expense 8

Compensation of Owners 9

Cost to Related Organizations 10

Return on Equity Capital of Proprietary Providers 12

Reasonable Cost of Therapy and Other Services

Furnished by Outside Suppliers 14

Costs Related to Patient Care 21

Determination of Cost of Services to Benefciaries

(Cost Apportionment Chapter) 22

Adequate Cost Data and Cost Finding 23

Payment to Providers (Payment Process Chapter) 24

Limitations on Coverage of Costs Under Medicare

and Notice of Schedule of Limits on Provider Costs 25

Lower of Cost or Charges 26

ESRD Services and Supplies (Outpatient 27

Topic Chapter Reference in

“Provider

Reimbursement

Manual,” Part I

Maintenance Dialysis Services)

Prospective Payments 28