§411.53. Basis for conditional Medicare payment in no-fault cases.
42 C.F.R. § 411.53
A conditional Medicare payment may be made in no-fault cases under either of the following circumstances:
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.
The beneficiary, because of physical or mental incapacity, failed to meet a claim-filing requirement stipulated in the policy.
Any conditional payment that CMS makes is conditioned on reimbursement to CMS in accordance with subpart B of this part.
Notes, amendments, and revision history
Amendments
[71 FR 9470, Feb. 24, 2006]
Authority
Authority: 42 U.S.C. 1302, 1395w-101 through 1395w-152, 1395hh, and 1395nn.
Source
Source: 54 FR 41734, Oct. 11, 1989, unless otherwise noted.
Amendments
[71 FR 9470, Feb. 24, 2006]