42 U.S.C. § 1395h — Provisions relating to the administration of part A

(a) In general. The administration of this part must be carried out through contracts with Medicare administrative contractors under section 1395kk–1 of this title. (b) Repealed. (c) Prompt payment of claims. (1) Repealed. (2)(A) Every contract under section 1395kk–1 of this title that provides for Part A payments must require that payment be issued, mailed, or otherwise sent for at least 95 percent of all claims submitted under this subchapter within the applicable number of calendar days after the claim is received, if the claim is a "clean claim" and payment is not being made through periodic interim payments. (B) In this paragraph: (i) A "clean claim" means a claim with no defect, improper element, missing required supporting document, or special circumstance that prevents timely payment under this subchapter. This section does not otherwise define those terms. (ii) The "applicable number of calendar days" is 30 days for claims received in the 12 months beginning October 1, 1986; 26 days for claims received in the 12 months beginning October 1, 1987; 25 days for claims received in the 12 months beginning October 1, 1988; 24 days for claims received in the 12 months beginning October 1, 1989, and in each later 12-month period ending on or before September 30, 1993; and 30 days for claims received in the 12 months beginning October 1, 1993, and in each later 12-month period. (C) If payment is not sent within that applicable period after a clean claim is received from a hospital, critical access hospital, skilled nursing facility, home health agency, hospice program, comprehensive outpatient rehabilitation facility, or rehabilitation agency, and the provider is not receiving periodic interim payments for those services, interest must be paid. The interest rate is the rate used under section 3902(a) of title 31 for late-payment interest penalties. Interest runs from the day after the required payment date through the payment date. (3)(A) Every contract under section 1395kk–1 that provides for Part A payments must also require that no payment be sent for a claim submitted under this subchapter during the applicable number of calendar days after the claim is received. (B) Here, the applicable period is 13 days for claims submitted electronically as the Secretary requires, and 28 days for claims submitted in another way. (d) through (i) Repealed. (j) Denial of claim; notification and reconsideration. A contract with a Medicare administrative contractor for administering this part must require that, when the contractor denies a provider's claim for home health services, extended care services, or post-hospital extended care services, the contractor must: (1) give the provider and the individual for whom the claim was made a written explanation of the denial and its statutory or regulatory basis; and (2) if reconsideration is requested, promptly tell the individual and the provider the result of the reconsideration. (k) Annual reporting requirement on erroneous payment recovery. A contract for administering this part must require the contractor to give the Secretary an annual report describing the steps taken to recover payments for items or services for which payment has been or could be made under a "primary plan," as defined in section 1395y(b)(2)(A) of this title. This section does not define "primary plan." (l) Repealed.