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what is a medicare qualifying hospital stay for snf admission

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By , January 28, 2018 2:38 am

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what is a medicare qualifying hospital stay for snf admission

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Medicare Coverage of Skilled Nursing Facility Care –

plan know you need SNF care before you're admitted to the SNF. If you don't tell
…. need another qualifying 3‑day hospital stay to get additional SNF benefits.

Are You a Hospital Inpatient or Outpatient? –

Did you know that even if you stay in a hospital overnight, you might still be
considered … doctor decide if the patient needs to be admitted as an inpatient or
can be …. Medicare will only cover care you get in a SNF if you first have a “

Medicare Benefit Policy Manual –

benefit's qualifying hospital stay requirement, inpatient status commences with
the … they do not have a 3-day hospital stay before SNF admission, if admitted to

(SNF) 3-Day Rule Waiver –

Dec 9, 2016 … criteria upon admission to the anchor hospitalization: … The beneficiary's
eligibility for Medicare is not on the basis of the End Stage Renal.


Jun 1, 2017 … Medicare Shared Savings Program | SNF 3-Day Rule Waiver Guidance ….. not
preceded by a qualifying 3-day inpatient hospital stay for eligible beneficiaries ….
to the SNF admission by an ACO provider/supplier who is a …

SNF Billing Reference –

begins the day the Medicare beneficiary is admitted to a hospital or SNF as an
inpatient …. Occurrence span code 70 with the dates of the qualifying hospital

Medicare General Information, Eligibility, and Entitlement –

10.4.3 – Definition of Hospital or SNF for Ending a Benefit Period. ….
benefit period begins on admission to the qualified hospital. Admission to a …
discharge from a qualifying prior hospitalization and the initiation of SNF care can

Skilled Nursing Facility (SNF) 3-Day Waiver Application … –

Jun 13, 2016 … o Beneficiary eligibility and SNF affiliate eligibility for waiver … Waives the
requirement for a 3-day inpatient hospital stay prior to a … Approved for
admission to a SNF 3 days prior to the SNF admission at the direction of an.

CMS Manual System –

Sep 15, 2006 … qualifying stay may take place for purposes of SNF coverage. All other … and, the
3 day qualifying hospital stay requirement. We have …. they do not have a 3-day
hospital stay before SNF admission, if admitted to the SNF.


May 11, 2016 … (MACs) for services provided to Medicare beneficiaries. … and Human Services
is permitted to waive “such requirements of . . . title XVIII of this Act … SNF or
admitted to a SNF after an inpatient hospital stay of fewer than 3 …

Documentation for MEDPAR files – Healthcare Delivery Research …

Nov 1, 2016 … Inpatient hospital or in a skilled nursing facility (SNF) which may include … data
from claims for services provided to Medicare beneficiaries admitted …. For SNF
claims, the date relates to the qualifying stay from a hospital that …

Arkansas Nursing Home Consumer Guide – DHS Division of Aging …

before admission to a Medicare-certified skilled nursing home. In addition, you …
3-day qualifying hospital stay to get additional nursing home benefits. This is …

GAO-01-816 Skilled Nursing Facilities: Services Excluded From …

Aug 22, 2001 … services provided to Medicare beneficiaries during a SNF stay were excluded
from … are excluded only if they are provided in a hospital outpatient department,
… occurred within 30 days before admission to the SNF. For beneficiaries who
qualify, Medicare will pay for all necessary services, including room.

Impact of the Medicare Catastrophic Coverage Act on … – NCBI

care Catastrophic Coverage Act (MCCA) of 19882 altered eligibility and
coverage for skilled … discharge from the hospital or from a consecutive stay in a
SNF. …. hospital admission, if there is no return to the nursing home within. 60
days, the …

Accessible Version (PDF, 44 pages) – GAO

Sep 7, 2016 … residents following an acute care hospital stay. Most SNFs are …. SNF
expenditure data requirements in the Patient Protection and. Affordable Care …..
thresholds in both a short-stay sample of Medicare SNF admissions and.

Your Guide to Mental Health Benefits and Medicare –

Medicare. Partial hospitalization is a program of outpatient active psychiatric
treatment that's more … program, you must meet certain requirements …. admitted
as an inpatient in a hospital or in a. SNF. The benefit period ends after you haven'

Medicare – Social Security

inpatient care in a hospital or skilled nursing facility. (following a hospital stay).
Part A also pays for some … people qualify for both Medicare and Medicaid. For
more … A lawfully admitted noncitizen, who has lived in the. United States for at …

ODM Hospital Billing Guidelines – Ohio Department of Medicaid

Oct 1, 2015 … Pre-Certification, Prior Authorization Requirements, and Utilization …. Medicare
Part A Exhausted During Stay or Medicare Becomes ….. services within three
days of the admission date and the patient also changes Medicaid.

Why Medicare Matters to People Who Need Long … – Social Security

health, and skilled nursing facility (SNF) care. … For all figures, the ADLs with
which Medicare beneficiaries …. who qualify as needing skilled care may …
ments for prior hospitalization and limits on …. days, are admitted within 30 days
of that.

2017 MAPD Comparison of Benefits –

Aetna Medicare. Hospitalization … MA-PD PPO Plan. All Benefits are Based on
Medicare-Covered Services …. Waived if admitted inpatient to hospital. Skilled
Nursing Facility (Inpatient. Services) …. the minimum requirements for benefits as

which codes are covered by medicare for a psa

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By , January 27, 2018 12:34 am

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AARP life insurance (PDF download)

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which codes are covered by medicare for a psa

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Medicare Coverage Database – Centers for Medicare & Medicaid …

Apr 28, 2017 … The Medicare Coverage Database (MCD) contains all National … including
National Coverage Analyses (NCAs), Coding Analyses for Labs …

Medicare Preventive Services –

Clinical Modification (ICD-10) diagnosis codes; coverage requirements;
frequency requirements; and … Watch the “CMS Provider Minute: Preventive
Services” video for pointers to help you …… G0103 – Prostate Specific Antigen
Test (PSA).

Medicare National Coverage Determinations (NCD) Coding Policy …

Jan 1, 2017 … Medicare National Coverage Determinations (NCD). Coding Policy Manual and
Change Report (ICD-10-CM). *January 2017 Changes.

Medicare –

with HCPCS code G0103, prostate specific antigen blood test. … Screening PSA
tests are covered at a frequency of once every 12 months for men who.

Medicare Provides Coverage of Prostate Cancer … –

Jul 10, 2014 … parameters, and correct coding when billing for prostate cancer … Medicare
defines a screening PSA as a test that measures the level of …

Bulletin Number: xxxxxx –

Apr 5, 2013 … CM Codes Covered by Medicare, ICD-9-CM Codes Not Covered by Medicare,
and … Men with BPH receiving an annual PSA screening.

Your Guide to Medicare's Preventive Services –

2-year calendar of the Medicare-covered tests and screenings you're eligible for,
and ….. Prostate cancer may be found by testing the amount of PSA (Prostate …

Clinical Diagnostic Laboratory Fee Schedule 2016 CPT codes …

NOTE: Zero pay (0.00) codes will be reimbursed at 45% of billed charges. ** The
appearance on this schedule of a code and rate is not an indication of coverage. ,
nor a guarantee of payment. All rights reserved … of Medicare). 36415. Routine
venipuncture. 3.00 …… Assay of psa complexed. 25.06. 84153. Assay of psa total.

10050 Medicare & You 2017 –

Oct 1, 2016 … If you reach the coverage gap in your Medicare prescription drug coverage, you'll
qualify ….. Prostate screening (PSA test) 55. Publications 120.

Medicare & You 2016 –

Oct 1, 2015 … has grown and today provides quality health coverage … 37 What services does
Medicare cover? ….. Prostate screening (PSA Test) 62, 70.

module 4: medicare part b medical insurance – New York State …

Medicare Part B is coverage of medical services such as doctor visits, outpatient
care, ambulance services … and supplies not covered by Medicare Part A
hospital insurance. Module 4 ….. procedure code number of the service the
physician provided is NOT 99201 through 99215, or ….. Prostate-Specific Antigen
(PSA) test.

Benefit Choice Options –

May 1, 2016 … covered service, calculated as a percentage of the allowed amount for the
service. …. Plan Participants Eligible for Medicare. ….. HMO Illinois (Code: BY).
$100. $139. $ 79 …… Prostate cancer screening (PSA). • Men ages 50 …

Montana Medicaid – Fee Schedule Physician Services January 1 …

Jan 1, 2017 … RBRVS: Based on Medicare Relative Value Units (RVU's) x Montana Medicaid
conversion factor x policy adjuster. … *If a valid, current code is not present, that
code may be a non-covered service. Fees …… PSA SCREENING.

114.3 cmr 20.00:__clinical laboratory services – Mass.Gov

Aug 1, 2014 … set forth in 101 CMR 320.00 do not apply to individuals covered by M.G.L. c. …
codes at 74.67% of prevailing or existing Medicare fees when Medicare fees are
available. …… Prostate specific antigen (PSA); complexed.

A Complete Guide to Health Care Coverage for Older … –

Feb 28, 2017 … You are eligible for Medicare if you are 65 years old or older, and a citizen or …..
Prostate Specified Antigen (PSA) blood screening test: Covered once every 12
months ….. *First United American premiums differ by zip code.

Eligibility for the state's benefit plans –

Oct 15, 2016 … to enroll in the plan if you are not covered under the 2016 Wellness CDHP. ….. if
outside the 317 area code, to initiate the disabled dependent …. are covered by
Medicare, Medicaid ….. specific antigen (PSA) testing is a.

471-000-520 – Nebraska Department of Health and Human Services

The five-digit numeric codes included in the Schedule are obtained from the …
Use is limited to use in Medicare, Medicaid, or other programs administered by …

HealthChoice Health handbook for PY2017 –

of the eligibility rules and what the plans cover, limit and exclude. … date of birth,
HealthChoice ID number, ZIP code, and the last four digits of your Social ……
Facility must have a national certification (CARF/JCAHO) or a Medicare

GAO-12-81, Medicare: Use of Preventive Services Could Be Better …

Jan 18, 2012 … Medicare coverage is limited—and influenza and pneumococcal immunizations
was generally … Table 10: Use of PSA Tests by Male Medicare FFS Beneficiaries
… Healthcare Common Procedure Coding System. HEDIS.

Casefinding/ICD-10-CM Updates

Oct 1, 2016 … Source: Centers for Medicare and Medicaid Services (CMS) … sensitivity status (
new codes Z19.1-Z19.2) and/or rising PSA following treatment …

why isn't there a fee schedule for j codes

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By , January 26, 2018 3:43 pm

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Medicare replacement (PDF download)

AARP MedicareRx Plans United Healthcare (PDF download)

AARP life insurance (PDF download)

medicare benefits (PDF download)

medicare part b (PDF download)

why isn't there a fee schedule for j codes

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Chapter 16: Medication Administration and Injections

Jul 1, 2016 … By report (BR): A code listed in the fee schedule as “BR” doesn't have an … Note:
Catastrophic injuries, in which significant recovery of physical function isn't …
There are many commercially available, FDA approved alternatives, on the ….
Providers must use the HCPCS J codes for injectable drugs that are …

MARFS Payment Policies for Healthcare Services Provided to …

Jul 1, 2016 … Medical Aid Rules and Fee Schedules (MARFS) …. above elements isn't included
, it is because the information isn't … authorized billing codes providers use to bill
for services, …. There are two places to look for information about a specific …..
Link: For more information, refer to WAC 296-20-220(1)(j).

MM8204 –

The CY 2013 fee schedule amounts for HCPCS codes L8680 and L8682 … other
interpretive materials for a full and accurate statement of their contents. …. o
A4234 Replacement Battery, Alkaline, J Cell, For Use with Medically Necessary
Home … News Flash – Flu Season Isn't Over – Continue to Recommend
Vaccination …

Instructions for Form 990 – Internal Revenue Service

Section references are to the Internal Revenue Code unless otherwise noted.
Contents …. Appendix J. Contributions . … Appendix D and the Instructions for
Schedule B (Form 990,. 990-EZ, or …. for the year and if there was any transfer of
funds between the … (1) (if it isn't treated as a private foundation) is required to

2016 Instruction 1040 Schedule J – Internal Revenue Service

Use Schedule J (Form 1040) to elect to figure your 2016 income tax by …
Revenue Code unless otherwise noted. … There is a fee for each return
requested. See Form 4506 for the fee amount. …. on your 2013 Schedule D, line
21, isn't allowed …

2016 Instructions for Schedule J (Form 990)

Code unless otherwise noted. … Schedule J (Form 990) is used by an
organization that files Form … If an organization isn't required to file. Form 990 but
…. doesn't include membership fees for an ….. their reportable compensation, by
definition …

Form 1116 Instructions – Internal Revenue Service

This election isn't available to estates … income taxes on Schedule A (Form ….
country in which there is cumulative ….. Line 16, codes I, J, and K, or line 14,.

APC Frequently Asked Questions – Mississippi Division of Medicaid

Mar 8, 2013 … schedule and effective for claims with dates of service on or after September 1,
2012. …. Medicare payment policy isn't always appropriate for Medicaid and the
desire to … If there is a Medicare APC assigned to the code, the fee will be the
Mississippi …. J & Q HCPCS that are exclusively associated with.

Third Party Billing (ABM) – Indian Health Service

Jun 9, 2012 … new option will allow users to select a CPT code in a fee schedule …. Made field
SV101-2 populate with J3490 if there isn't a CPT entered on.

Clinic Institutional Informational Virtual Training … – State of Michigan

May 30, 2017 … A: Yes, all clinic providers will be required to have a payment code … A: Medicaid
will not require a charge to be reported on the qualifying visit line(s). … CPT/
HCPCS that would receive an actual payment, if there are any such as “J”codes?
… to Medicaid it states the GC modifier isn't valid, should we use a …

Construction Code Communicator – State of New Jersey

Nov 30, 2012 … Division of Codes and Standards, P.O. Box 802, Trenton, NJ 08625-0802 www.nj
.gov/dca/divisions/codes. Construction … efforts to give their clients accurate
move-in dates because ….. 45:5A-18(j … The State's fee schedule provides a
mechanism to ….. Some of you might think, isn't the system's inverter.

Podiatric Services – Iowa Department of Human Services –

Jan 1, 2016 … reimbursed for the interpretation but only for their medical services. a. ….
determined that there are any “J,” “Q,” or “S” code physician-administered drugs
that are covered and … While this isn't required per IL 699, this is necessary …
Click here to view the Podiatric Services fee schedule online. The charges …


Dec 21, 2016 … Review, which applied the California Official Medical Fee Schedule (OMFS) in
setting the … and Iowa Administrative Code rule 876-10.3. 2. In a letter to ….
Center, there is an obvious conflict in Mr. Kauffman's serving as the ….. isn't
equipped to evaluate those claims would create confusion and uncertainty.

2017 Medicare Supplement Premium Comparison Guide –

specific insurance plans in Illinois, and the approximate amount they charge by
age when you … Rates are quoted based on a regional zip code. …. not need a
Medicare Supplement Policy, as all their Medicare services must be …. retained
an H, I or J policy issued prior to January 1, 2006. … isn't available, you can buy.

Markadonatos v. Village of Woodridge – Opinions, Nonprecedential …

Jul 21, 2014 … There is a critical difference between a fee for posting bail and a fee … (1971),
states that “§ 110-7 [of Article 110 of the Illinois Code …. See Henry J. Friendly,
Benchmarks 211–12 …. son the plaintiff isn't asking for an injunction is that the Vil
- ….. a line item in an otherwise unremarkable schedule of adminis-.

Tennessee's Court Fees and Taxes: Funding … – State of Tennessee

Appendix J: Collection Rates Reported by the Tennessee Administrative …
schedules based on fixed or flat rates, and should be codified in one place to …
There are 245 separate court fees and taxes in Tennessee, and they vary by the
court, …. The one tax that isn't earmarked is a $2 state tax on most civil and
criminal …

2016 Board Rule Comments-2.D.5. 217 … – TxDMV.GOV

May 20, 2016 … Proposed TAC,Ch. 217, New Subchapter I, Fees,Subsection 217.181-217.185; …
The Tax Assessor Collector with their County …. Texas Administrative Code
Chapter 217, Subchapter I, regarding Fee Changes. ….. Tammy J. McRae …
Section 217.165- Inspection Deputies: This proposed change isn't …

dealer –

The Dealer must use their assigned Account Number and PIN number, issued by
BMV Cash Office. There is NO annual BMV subscription fee for an account. …
FEE SCHEDULE. MVT- ….. William J. Newport, President ….. Codes. • Enforce the
Used Car Information. Act. • Enforce Rules of Secretary of State …. If it isn't signed

Information –

This isn't a tax return,. P. Keep …. City, town or post office, state, and ZIP code. If
you have a …. 27 Deductible part of self-employment tax, Attach Schedule SE . …
34 Tuition and fees. …… If you used Schedule J to figure your tax on Form 1040,.

SEVIS Names FAQ – Study in the States

Oct 30, 2014 … Q: What is the schedule for implementation of the name changes? … Q: What if
there is no MRZ in the passport, but there is a U.S. visa with an MRZ? ….. Q: Will
the name conversion affect the I-901 Fee Payment System? ….. No, we share our
naming standards with other government entities, but there isn't a.

when is it appropriate to use discharge status code 09 on a medicare hospital claim?

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By , January 24, 2018 8:54 pm

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AARP life insurance (PDF download)

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medicare part b (PDF download)

when is it appropriate to use discharge status code 09 on a medicare hospital claim?

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Clarification of Patient Discharge Status Codes and Hospital …

Mar 15, 2017 … is located in the "Medicare Claims Processing Manual" (100-04), Chapter 3. For
questions concerning clarification on the proper usage of …

Clarification of Patient Discharge Status Codes and Hospital

Jan 23, 2008 … Choosing the patient discharge status code correctly avoids claim errors and …
The Centers for Medicare & Medicaid Services (CMS) requires patient discharge
status codes for: … Usage Note: Transfers to non-designated cancer hospitals
should use Code 02. … 09 – Admitted as an Inpatient to this Hospital.

CMS Manual System –

Oct 5, 2009 … apply to claims that contain patient discharge status code 21. B. Policy: Field ….
1718, Issued: 04-24-09, Effective: 10-01-09, Implementation: 10-05-09) … Usage
Note: Cancer hospitals excluded from Medicare PPS and.

SNF Billing Reference –

codes and descriptions; and/or making any commercial use of UB-04 … The
American Hospital Association (the “AHA”) has not reviewed, and is not ….. For
more information on SNF Part B billing, refer to the Medicare Claims Processing
Manual, …. Discharge the beneficiary using the appropriate discharge status

Medicare Claims Processing Manual Crosswalk –

This section contains Medicare requirements for use of codes maintained by …
FL09 Patient Address – City ….. This code indicates the patient's discharge status
as of the … The Long Term Care Hospital (LTCH), Inpatient Psychiatric Facility (
IPF), and …. Follow the CMS manual instructions for appropriate assignment of

Inpatient Hospital Billing –

Apr 27, 2007 … Pub 100-04 Medicare Claims Processing Centers for Medicare & … This Change
Request (CR) redefines the policy to use the benefits exhaust … submitted with a
patient status code of 30 (still an inpatient), also known …. a 110 with dates of
service 09/29/07 through 10/05/07, with the appropriate discharge.

CMS Manual System –

Jan 5, 2009 … patient prior to their discharge to the hospital for a qualifying hospital stay. …
Medicare contractors shall reject SNF claims subject to a payment ban. …. iii)
Patient Status Code = Use appropriate code other than patient status code 30 ….
09). The SNF must file a covered bill with the FI using occurrence span …

Medicare Claims Processing Manual –

Medicare beneficiaries entitled to hospital insurance (Part A) who have terminal
… Claims for “Hospice Pre-Election and Counseling Services”, HCPCS code
G0337, are ….. For the day of discharge from an inpatient unit, the appropriate
home care rate is to be …. Billing Period: 12/01/XX – 12/09/XX, Patient Status: 40.

CMS Manual System –

Nov 2, 2007 … apply to claims that contain patient discharge status code 70. B. …. Usage Note:
Cancer hospitals excluded from Medicare PPS and … *09. Admitted as an
inpatient to this hospital. 10-19 Reserved for National Assignment. 20.

Medicare Inappropriately Paid Hospitals' Inpatient Claims Subject to …

Medicare Claims Subject to the Postacute Care Transfer Policy … The objective
of this review was to determine whether Medicare appropriately paid hospitals' …
policy. The hospitals used incorrect patient discharge status codes on their
claims, ….. Medicare contractors use the Fiscal Intermediary Standard System (
FISS) to …

Top 50 Billing Error Reason Codes With Common Resolutions – DMAS

(09-12). On the following table you will find the top 50 Error Reason Codes with
Common … Verify the enrollee eligibility and bill the claim to the appropriate.

HDDS User Manual – State of Tennessee

2011 Hospital Discharge Data System User Manual. 2 ….. patient discharge
status code has been added at the national level for any prisoner from whom a.

South Dakota Medicaid – South Dakota Department of Social Services

1-800-597-1603. Medicare. 1-800-633-4227. Division of Medical Services ….
manual is one of a series published for use by medical services providers
enrolled in ….. To determine the status of a claim, providers must reconcile the
information on the.

short-doyle/medi-cal provider billing manual – California Department …

3.1.3 Added MMEF description. 3.1.4 Added information on MEDS eligibility
status codes. 3.2 Inserted section on Aid Codes. 5.3 Added section on billing
Other …

ICD-10 Frequently Asked Questions Send your … – Georgia Medicaid

Oct 30, 2015 … EDI and populate error status code 4040 on the transmitted file. … Outpatient
claim where the date of service is on or after October 1, 2015, how … describe an
injury using an ICD-10 CM (diagnosis) code. 6. … How do you bill Inpatient
Hospital Procedure codes? ….. ICD-10 Medicare Crossover Claims. 36.

ub-04 claim form instructions – eohhs –

PR0041 V1.4 09/16/16. UB-04 CLAIM FORM … Enter the name and address of
the hospital/facility submitting the claim. 2 … Enter the hour (using a two-digit
code below) that … Patient Discharge Status. Enter the … If Medicare is the
primary payer, indicate Part A … Enter the appropriate ICD diagnosis code that

Hospital Billing Book, complete – Missouri Department of Social …

Jun 21, 2013 … Section 6: Revenue Codes – Outpatient Hospital Facility. Section 7: … Section 9:
Medicare/MO HealthNet Crossover Claims. Section 10: …

Chapter IV. Billing Iowa Medicaid – Iowa Department of Human …

Professional claim use the EXT Pat/Gen (2) tab. …. 3 Outpatient hospital,
outpatient SNF or …. for accepted discharge hour codes. 17 STAT (Member.

Texas Hospital Inpatient Discharge – Texas Department of State …

elements available with the collection of data from hospitals using the THCIC 837
format. … Following the correction process, DSHS uses valid claims …. Patient
Status codes of 62 (discharged/transferred to inpatient rehabilitation), 71 ….. OK
Oklahoma …. Discharged/transferred to Medicare-certified long term care hospital

Fee-For-Service Provider Manual – ahcccs

Apr 7, 2014 … Services must be billed using appropriate CPT and HCPCS codes and …
AHCCCS follows Medicare's Correct Coding Initiative (CCI) policy and … edits
and audits on fee-for-service claims for the same provider, …. Physical status
codes …. The E/M codes for hospital discharge day management are used to …

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