42 CFR 411.53 - Basis for conditional Medicare payment in no-fault cases.

Regulations last checked for updates: Oct 31, 2024

Title 42 - Public Health last revised: Oct 29, 2024

View all text of Subpart D [§ 411.50 - § 411.54]

§ 411.53 - Basis for conditional Medicare payment in no-fault cases.

(a) A conditional Medicare payment may be made in no-fault cases under either of the following circumstances:

(1) The beneficiary has filed a proper claim for no-fault insurance benefits but the intermediary or carrier determines that the no-fault insurer will not pay promptly for any reason other than the circumstances described in § 411.32(a)(1). This includes cases in which the no-fault insurance carrier has denied the claim.

(2) The beneficiary, because of physical or mental incapacity, failed to meet a claim-filing requirement stipulated in the policy.

(b) Any conditional payment that CMS makes is conditioned on reimbursement to CMS in accordance with subpart B of this part.

[71 FR 9470, Feb. 24, 2006]

authority: 42 U.S.C. 1302,1395w,1395hh,and

source: 54 FR 41734, Oct. 11, 1989, unless otherwise noted.

cite as: 42 CFR 411.53