What 42 CFR Part 411 - CMS Medicare Secondary Payer Rules and Recovery requires
42 CFR Part 411 implements the Medicare Secondary Payer (MSP) rules administered by the U.S. Centers for Medicare & Medicaid Services, and sets out certain exclusions from Medicare coverage. Where another payer is primary to Medicare, that primary payer and entities that received payment from it have reimbursement obligations, and Medicare may make conditional payments that must be repaid. The beneficiary must cooperate in Medicare's recovery, and Medicare may recover conditional payments, including through subrogation and a right to intervene. A primary payer must give notice of its primary payment responsibility, and CMS may waive recovery or compromise claims in defined circumstances. The Part also identifies particular services excluded from Medicare coverage. These rules ensure Medicare pays secondary to liability, no-fault, workers' compensation and group health plan coverage as required by law.
Pillar: Medical & Healthcare · Authority: US Centers for Medicare & Medicaid Services (CMS) · Version: 1.0.0 · Last updated:
Primary source: https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-411
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Primary Citations — 9 traced to source
- Social Security Act, 42 U.S.C. 1395y(b) (Medicare Secondary Payer) - statutory authority
- 42 CFR Part 411, § 411.20 and § 411.21 - basis, scope and definitions of the MSP rules
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