(a) Research patient care costs are the costs
of routine and ancillary services provided to patients participating
in research programs described in this contract.
(b) Patient care costs shall be computed in
a manner consistent with the principles and procedures used by
the Medicare Program for determining the part of Medicare reimbursement
based on reasonable costs. The Diagnostic Related Group (DRG)
prospective reimbursement method used to determine the remaining
portion of Medicare reimbursement shall not be used to determine
patient care costs. Patient care rates or amounts shall be established
by the Secretary HHS or her duly authorized representative.
(c) Prior to submitting an invoice for patient
care costs under this contract, the contractor must make every
reasonable effort to obtain third party payment, where third party
payors (including Government agencies) are authorized or are under
a legal obligation to pay all or a portion of the charges incurred
under this contract for patient care.
(d) The contractor must maintain adequate procedures
to identify those research patients participating in this contract
who are eligible for third party reimbursement.
(e) Only those charges not recoverable from
third party payors or patients and which are consistent with the
terms and conditions of the contract are chargeable to this contract.