TAILIEUCHUNG - MEDICARE CREDIT BALANCE REPORT CERTIFICATION PAGE

The properties of nonsophisticated borrowers’ competitive-equilibrium contracts, and the restriction disallowing disproportionately large penalties for deferring small amounts of repayment, have close parallels in real-life credit markets and their regulation. As has been noted by researchers, the baseline repayment terms in credit-card and subprime mortgage contracts are typically quite strict, and there are large penalties for deviating from these terms. For example, most subprime mortgages postulate drastically increased monthly payments shortly after the origination of the loan or a large “balloon” payment at the end of a short loan period, and failing to make these payments and refinancing triggers significant prepayment penalties | DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE MEDICAID SERVICES Form Approved OMB No. 0938-0600 MEDICARE CREDIT BALANCE REPORT CERTIFICATION PAGE The Medicare Credit Balance Report is required under the authority of sections 1815 a 1833 e 1886 a 1 C and related provisions of the Social Security Act. Failure to submit this report may result in a suspension of payments under the Medicare program and may affect your eligibility to participate in the Medicare program. ANYONE WHO MISREPRESENTS FALSIFIES CONCEALS OR OMITS ANY ESSENTIAL INFORMATION MAY BE SUBJECT TO FINE IMPRISONMENT OR CIVIL MONEY PENALTIES UNDER APPLICABLE FEDErAl laws. CERTIFICATION BY OFFICER OR ADMINISTRATOR OF PROVIDER I HEREBY CERTIFY that I have read the above statements and that I have examined the accompanying credit balance report prepared by Provider Name Provider 6-Digit Number for the calendar quarter endedand that it is a true correct and complete statement prepared from the books and records of the provider in accordance with applicable Federal laws regulations and instructions. Sign Officer or Administrator of Provider Print _ Name and Title Print Date CHECK ONE Qualify as a Low Utilization Provider. The Credit Balance Report Detail Page s is attached. There are no Medicare credit balances to report for this quarter. No Detail Page s attached. Contact Person Telephone Number INSTRUCTIONS FOR COMPLETING THIS PAGE ARE IN MEDICARE CREDIT BALANCE REPORT -PROVIDER INSTRUCTIONS FORM CMS-838 Form CMS-838 10 03 Form Approved OMB No. 0938-0600 Department of Health and Human Services Centers for Medicare Medicaid Services Medicare Credit Balance Report Detail Page Provider Name Page of Provider Number Contact Person Quarter Ending Phone Number - Medicare Part Indicate A

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• Surgical Treatment
• Laparoscopic Surgery
• Severe Ulcerative Colitis
• Angiographic Stenosis
• Optimization
• Radiation Dose
• Summary of Medical thesis
• Morphological characteristics of multilevel thoracic
• Lumbar vertebral fracture
• Effectiveness of surgical treatment
• Surgical treatment results
• Lower third gastric cancer
• Gastric cancer
• Long term outcome
• Perioperative chemotherapy
• Multimodal approach to treatment
• Multimodal treatment
• Epidemiology
• Risk Factors
• Hepatocellular Carcinoma
• Liver Metastases
• Clinical cases in endodontics
• Non surgical root canal treatment case
• Canal treatment case
• Non Surgical Re treatment case
• Periapical surgery case
• Traumatic injuries
• BMC Musculoskeletal Disorders
• Odontoid fractures
• Conservative treatment
• Prospective cohort study
• Cervical spine
• Surgical Therapy
• Patient Assessment
• Movement Disorders
• Peripheral Denervation
• Synaptic Connectivity
• BMC Cancer
• High inguinal orchiectomy
• Testis sparing surgery
• Surgical margin
• Paratesticular leiomyosarcoma
• Negative surgical margin
• Anorectal malformations
• Basic anatomy
• Pediatric colorectal surgery
• Prenatal diagnosis
• Neonatal management
• Bowel preparation
• Rectal atresia
• Rectovestibular fistula
• Antegrade enemas
• Hirschsprung’s disease
• Idiopathic constipation
• Wilms tumor or nephroblastoma
• SIOP 2001 algorithm
• Kidney tumors
• Clear cell sarcoma
• BMC Pediatrics
• Vascular anomalies
• Kasabach Merritt phenomenon
• Life threatening occasion
• Breast Neoplasms
• Female health services
• Survival rate
• Breast cancer
• Ruptured lumbar disc herniation
• Non surgical treatment
• Traditional Chinese medicine
• Natural outcome
• Summary of Doctoral thesis
• Summary of Medical Doctoral thesis
• Efficacy of surgical treatment
• Recurrent retinal detachment
• Rotator cuff
• Rotator cuff tear
• Rotator cuff repair
• Melanoma morbidity
• Skin cancer
• Melanoma surgical treatment
• Melanoma quality improvement
• Humeral head
• Proximal humeral fractures
• Modified Neer Criteria
• Non surgical methods
• Clavicle fractures
• Visual analogue scale
• BMC Anesthesiology
• Preoperative multidisciplinary conference
• Challenging surgical treatment option
• Patient safety
• Shared decision making
• Multidisciplinary meetings
• Effects of coumestrol treatment
• Coumestrol treatment
• Spermatogenesis in dogs
• Coumestrol treatment on spermatogenesis in dogs
• Non surgical fertility control
• Treatment beliefs
• Measurement instrument
• Treatment modalities
• Surgical treatment modalities
• The paediatric patient
• Surgical practice
• Surgical care
• Thoracic surgery
• Early treatment
• Lower gastrointestinal surgery
• Achilles tendon
• Non surgical
• Heel rise test
• Non inferiority analysis
• Peripheral nerve
• Multiple schwannomas
• Neurofibromatosis type 2
• Muscle weakness