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Importantly, serum B12 levels can be misleadingly normal or even elevated in chronic liver disease due to increased levels of binding proteins (such as haptocorrin) and reduced clearance, meaning that total B12 measurements may not accurately reflect tissue B12 status or functional deficiency

While CMS has previously treated section 1886(d)(8)(E) reclassifications as one among many reclassifications provided for under section 1886(d) and so limited its scope in several ways, we now read it to provide that a 412.103 reclassification functions the same as if the reclassifying hospital had physically relocated into a geographically rural area

5.Manual is in English

PMID 29436502