Federal
Basis for conditional Medicare payment in liability cases.
42 CFR § 411.52
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42 CFR § 411.52
42 CFR § 411.52
Basis for conditional Medicare payment in liability cases.
(a)
A conditional Medicare payment may be made in liability cases under either of the following circumstances:
(1)
The beneficiary has filed a proper claim for liability insurance benefits but the intermediary or carrier determines that the liability insurer will not pay promptly for any reason other than the circumstances described in § 411.32(a)(1). This includes cases in which the liability insurance carrier has denied the claim.
(2)
The beneficiary has not filed a claim for liability insurance benefits.
(b)
Any conditional payment that CMS makes is conditioned on reimbursement to CMS in accordance with subpart B of this part.
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