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