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Provisions also address deductibles, coinsurance amounts, payment rules, and limitations tied to utilization review and consecutive day thresholds.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/research-report/","Research & 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Subpart A of the hospital insurance regulations cover?","Question",{"text":63,"@type":64},"Subpart A sets eligibility conditions for hospital insurance benefits, defines the start and end dates of entitlement, and describes the items and services that may be paid for, along with payment conditions and limitations.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How does an individual become entitled to hospital insurance benefits under Subpart A?",{"text":68,"@type":64},"Entitlement is available to individuals who meet the Subpart A conditions, including reaching age 65 and meeting the specified criteria for monthly insurance benefits or qualifying railroad retirement beneficiary status.",{"name":70,"@type":61,"acceptedAnswer":71},"How are payments for covered hospital insurance services made?",{"text":72,"@type":64},"Payment for covered hospital insurance services is made to eligible providers of services rather than directly to the individual receiving the 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INSURANCEFOR THE AGED  \n(CoDE OF FEDERAL REGULATIONS,TrTLE 20,CHAPTER IHI,PART 405)  \nREGULATIONS  \nU.S.DEPARTMENT OF HEALTH,EDUCATION,AND WELFARE  \nSOCIAL SECURITY ADMINISTRATION  \nKF3608A11 326n0.11967   \n## PREFACE\n\nThis document sets forth Subpart A of the Social Security Administration's Regu-lations No.5(Federal Health Insurance for the Aged--20 C.F.R.405).Subpart Acontains the conditions an individual must meet for entitlement to hospital insur-ance benefits,defines the beginning and ending dates of such entitlement,thetypes of items and services for which payment may be made,and the conditionsfor such payment.  \nThis document was prepared for useby those individuals and organizations whichhave a need for a convenient reference source concerning hospital insurance ben-efits under title XVII of the Social Security Act.  \n## SUBPART AHOSPITAL INSURANCE BENEFITS\n\nSectionHospital Insurance Benefits;General ……   ……  ……    ………    …405.101Conditions for Entitlement to Hospital Insurance Benefits ……………      ……  ………405.102Duration of Entitlement to Hospital Insurance Benefits …  ………………·405.103Inpatient Hospital Services;Scope of Benefits ……  ……………  ………………405.110Inpatient Hospital Services;Determining the 90-Day Benefit Limitation—Inpatient of aPsychiatric or Tuberculosis Hospital………   …  …………………………………·405.111Inpatient Hospital Services;Services Considered for Purposes of 90-Day and 190-DayLimitations …………………………………   ……………    ………  …  ……  ………    …405.112Inpatient Hospital Services;Deductible ……  …   …………    ………       ….405.113Inpatient Hospital Services;Whole Blood Cost Deductible ……      ……   ………405.114Inpatient Hospital Services;Coinsurance Amount …  …  ………   ……    …405.115Inpatient Hospital Services;Defined…   ………  ……   ……    …  ………405.116Posthospital Extended Care Services;Scope cf Benefits …   …………………  …405.120Posthospital Extended Care Services;Services Considered for Purposes of Limitation onDays of Coverage ……………  ……………………    …………        …405.122Posthospital Extended Care Services;Whole Blood Cost Deductible ……………  …     405.123Posthospital Extended Care Services;Coinsurance Amount …     ……   ……405.124Extended Care Services;Defined……   …………    ……      ……   ……405.125Posthospital Home Health Services;General……  …  ……………………  ……·405.130Posthospital Home Health Services;Benefits Provided…………    ………………………405.131Outpatient Hospital Diagnostic Services;Conditions ……………………………………405.141Outpatient Hospital Diagnostic Services;Deductibles………………………  ………405.142Outpatient Hospital Diagnostic Services;Diagnostic Study Defined …  ………………405.144Outpatient Hospital Diagnostic Services;Defined ……            ……   …405.145Payment for Services Furnished;General……    ……………………………405.150Payment for Services Furnished;Determination of Amount Payable Based on Reasonable………………………………………    ……………………405.151Payment for Services Furnished;Nonparticipating Provider Furnishing EmergencyServices ………  …………     …  ……      …  ……  ………      …405.152Payment for Services;Hospital Outside the United States Furnishing Emergency Services..405.153Payment for Services Furnished;Federal Providers………………………    …………405.154Payment for Services Furnished;Providers Obligated To Furnish Services at PublicExpense …  ……………………       ………………………………  ………  …  405.155Payment for Inpatient Hospital Services;Conditions for Payment.……  …   ……405.160Payment for Inpatient Hospital Services;Furnished After 90-Day Limit or After 190-Day Limit ………………   ………  ……………………………  ………………………………………405.161Prohibition Against Payment for Inpatient Hospital Services Furnished After UtilizationReview Finding That Further Services Are Not Medically Necessary……………  …·405.162Prohibition Against Payment for Inpatient Hospital Services Furnished After 20thConsecutive Day by a Hospital Which Has Failed To Make Timely Utilization Review 405.163Payment for Posthospital Extended Care Services;Condition ……      ………405.165Prohibition Against Payment for Posthospital Extended Ca","cbCaisKupADA8sj7","https://ap.wps.com/l/cbCaisKupADA8sj7","pdf",841282,"English","# PREFACE\n# SUBPART A HOSPITAL INSURANCE BENEFITS\n## Hospital Insurance Benefits; General\n## Conditions for Entitlement to Hospital Insurance Benefits\n## Duration of Entitlement to Hospital Insurance Benefits\n## Inpatient Hospital Services; Scope of Benefits\n## Inpatient Hospital Services; 90-Day Benefit Limitation\n## Inpatient Hospital Services; 90-Day and 190-Day Limitations\n## Inpatient Hospital Services; Deductible\n## Inpatient Hospital Services; Coinsurance Amount\n## Posthospital Extended Care Services; Scope of Benefits\n## Posthospital Extended Care Services; Limitation on Days of Coverage\n## Posthospital Extended Care Services; Whole Blood Cost Deductible\n## Posthospital Extended Care Services; Coinsurance Amount\n## Extended Care Services; Defined\n## Posthospital Home Health Services; General\n## Posthospital Home Health Services; Benefits Provided\n## Outpatient Hospital Diagnostic Services; Conditions\n## Payment for Services Furnished; General\n## Payment for Inpatient Hospital Services; Conditions for Payment\n## Payment for Posthospital Extended Care Services; Condition","[{\"question\":\"What does Subpart A of the hospital insurance regulations cover?\",\"answer\":\"Subpart A sets eligibility conditions for hospital insurance benefits, defines the start and end dates of entitlement, and describes the items and services that may be paid for, along with payment conditions and limitations.\"},{\"question\":\"How does an individual become entitled to hospital insurance benefits under Subpart A?\",\"answer\":\"Entitlement is available to individuals who meet the Subpart A conditions, including reaching age 65 and meeting the specified criteria for monthly insurance benefits or qualifying railroad retirement beneficiary status.\"},{\"question\":\"How are payments for covered hospital insurance services made?\",\"answer\":\"Payment for covered hospital insurance services is made to eligible providers of services rather than directly to the individual receiving the services.\"}]","HOSPITAL INSURANCEBENEFITS - Regulations - Subpart A Hospital Insurance Benefits | PDF",1789965763]