4.2 Hospitals Which Do Not Charge
4.2.1 According to Section 1079(m)
of Chapter 55, Title 10, United States Code (USC), certain hospitals
can be excepted from the requirement that a beneficiary cost-share
be collected for every claim. In order to qualify for this exception
the hospital must certify in writing to the responsible contractor
that it will:
4.2.1.1 Not impose a legal obligation
of any kind on any of its patients; and
4.2.1.2 Accept and treat TRICARE beneficiaries
to the same extent as any other patient or category of patients;
and
4.2.1.3 Provide evidence that it has
sources of revenue to cover unbilled costs.
4.2.2 The contractor shall ensure
that payments to such hospitals do not exceed the average amount
paid for comparable services in the area and that the hospital’s
practice of not billing patients does not result in increased costs
to TRICARE.
4.2.3 Claims for professional services
may qualify for this exception only when they are billed through
a facility meeting the above criteria. Professional claims billed
under a different Employer Identification Number (EIN) or Social
Security Number (SSN) will not be exempt from imposing a legal obligation
on patients for payment of their cost-share or deductible.