Page:United States Statutes at Large Volume 103 Part 3.djvu/114

 103 STAT. 2182 PUBLIC LAW 101-239—DEC. 19, 1989 "(A) IN GENERAL.—Payment for physicians' services fur- nished on or after April 1, 1990, to an individual who is enrolled under this part and eligible for any medical assist- ance (including as a qualified medicare benei^ciary, as de- fined in section 1905(p)(l)) with respect to such services under a State plan approved under title XIX may only be made on an assignment-related basis. "(B) PENALTY.—A person may not bill for physicians* services subject to subparagraph (A) other than on an assignment-related basis. If a person knowingly and will- fully bills for physicians' services in violation of the pre- vious sentence, the Secretary may apply sanctions against the person in accordance with section 1842(j)(2). "(4) PHYSICIAN SUBMISSION OF CLAIMS.— "(A) IN GENERAL.—For services furnished on or after September 1, 1990, within 1 year after the date of providing ^ a service for which payment is made under this part on a reasonable charge or fee schedule basis, a physician, sup- plier, or other person (or an employer or facility in the cases described in section 1842(b)(6)(A))— Claims. "(i) shall complete and submit a claim for such serv- ice on a standard claim form specified by the Secretary to the carrier on behalf of a beneficiary, and "(ii) may not impose any charge relating to complet- ing and submitting such a form. "(B) PENALTY.—(i) With respect to an assigned claim wherever a physician, provider, supplier or other person (or an employer or facility in the cases described in section 1842(b)(6)(A)) fails to submit such a claim as required in subparagraph (A), the Secretary shall reduce by 10 percent the amount that would otherwise be paid for such claim under this part, "(ii) If a physician, supplier, or other person (or an em- li ployer or facility in the cases described in section 1842(b)(6)(A)) fails to submit a claim required to be submit- ted under subparagraph (A) or imposes a charge in viola- tion of such subparagraph, the Secretary shall apply the sanction with respect to such a violation in the same manner as a sanction may be imposed under section 1842(p)(3) for a violation of section 1842(p)(l). "(5) ELECTRONIC BILUNG; DIRECT DEPOSIT. —The Secretary shall encourage and develop a system providing for expedited pay- ment for claims submitted electronically. The Secretary shall also encourage and provide incentives allowing for direct de- posit as payments for services furnished by participating physi- cians. The Secretary shall provide physicians with such tech- nical information as necessary to enable such physicians to submit claims electronically. The Secretary shall submit a plan to Congress on this paragraph by May 1, 1990. "(6) MONITORING OF CHARGES. — "(A) IN GENERAL.—The Secretary shall monitor— "(i) the actual charges of nonparticipating physicians for physicians' services furnished on or after January 1, 1991, to individuals enrolled under this part, and "(ii) changes 0)y specialty, type of service, and geo- graphic area) in (I) the proportion of expenditures for physicians' services provided under this part by partici-

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