This paragraph applies to fee for freestanding ambulatory surgical facilities. It doesn’t apply to professional providers. A record of ambulatory surgical procedure procedures topic to the payment method set forth within the paragraph shall be published periodically by the Director, TRICARE Management Activity . Payment to freestanding ambulatory surgical procedure centers is proscribed to those procedures. CHAMPUS mental well being per diem payment system.
However, since a “temporary suspension of claims processing” is by definition not a ultimate or formal agency action, the premise for the motion usually won’t be disclosed. It is noted that the idea for the action is usually a results of questions arising from routine audits to investigation of potential legal violations. A temporary suspension of claims processing has been ordered and an announcement of the premise of the decision to droop payment. Unless the suspension is based on any of the actions set forth in paragraph of this section, the discover shall describe the suspected acts or omissions in phrases adequate to position the provider or beneficiary on notice with out disclosing the Government’s evidence.