Under Arrangement Agreement Sample Contracts

Effective Date: July 23, 2004 Skilled Nursing Facility: Bill Care Center Supplier of Services: Donna’s Dynamic DME
Under Arrangement Agreement • March 8th, 2021

The Skilled Nursing Facility (SNF) as identified above wishes to obtain services under arrangement from the Supplier of Services in accordance with 42 C.F.R. §483.75 as follows:

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resident’s name) is a Medicare beneficiary who is a resident of
Under Arrangement Agreement • August 8th, 2005

(name of SNF). Since Medicare Part A is covering this resident’s SNF stay, most of the services that he or she receives are subject to the consolidated billing requirement. Under this requirement, the SNF must include these services on its Part A bill for the resident’s Medicare-covered stay, and they are included within the comprehensive per diem that Part A pays the SNF for the covered stay. This means that when an outside Supplier furnishes such a service to the SNF’s resident, that entity must obtain payment for the service from the SNF, rather than from Medicare

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