§417.458. Recoupment of uncollected deductible and coinsurance amounts.
42 C.F.R. § 417.458
An HMO or CMP agrees not to recoup deductible and coinsurance amounts for which Medicare enrollees were liable in a previous contract period except in the following circumstances:
The HMO or CMP failed to collect the deductible and coinsurance amounts during the contract period in which they were due because of—
Underestimation of the actuarial value of the deductible and coinsurance amounts; or
A billing error.
The HMO or CMP has identified the amounts and obtained advance CMS approval of the recoupment and the method and timing of recoupment.
The HMO or CMP collects these amounts no later than the end of the contract period following the contract period during which they were found to be due.
Notes, amendments, and revision history
Amendments
[50 FR 1346, Jan. 10, 1985, as amended at 58 FR 38082, July 15, 1993; 60 FR 45678, Sept. 1, 1995]
Source
Source: 50 FR 1346, Jan. 10, 1985, unless otherwise noted.
Authority
Authority: 42 U.S.C. 1302 and 1395hh, and 300e, 300e-5, and 300e-9, and 31 U.S.C. 9701.
Amendments
[50 FR 1346, Jan. 10, 1985, as amended at 58 FR 38082, July 15, 1993; 60 FR 45678, Sept. 1, 1995]