Source: https://www.govregs.com/regulations/42/424.55
Timestamp: 2020-08-12 21:09:09
Document Index: 727108396

Matched Legal Cases: ['§ 424', 'art 424', '§ 424', '§ 424', '§ 424', '§ 410']

42 CFR 424.55 - Payment to the supplier. § 424.55 - Payment to the supplier.
All TitlesTitle 42Chapter IVPart 424Subpart D - To Whom Payment Is Ordinarily Made
View all text of Subpart D [§ 424.50 - § 424.58]
§ 424.55 - Payment to the supplier.
(a) Medicare pays the supplier for covered services if the beneficiary (or the person authorized to request payment on the beneficiary's behalf) assigns the claim to the supplier and the supplier accepts assignment.
(b) In accepting assignment, the supplier agrees to the following:
(1) To accept, as full charge for the service, the amount approved by the carrier as the basis for determining the Medicare Part B payment (the reasonable charge or the lesser of the fee schedule amount and the actual charge).
(3) Not to charge the beneficiary when Medicare paid for services determined to be “not reasonable or necessary” if -
(i) The beneficiary was without fault in the overpayment; and
(ii) The determination that the payment was incorrect was made by the carrier after the third year following the year in which the carrier sent notice to the beneficiary that it approved the payment.
(c) Exception. In situations when payment under the Act can only be made on an assignment-related basis or when payment is for services furnished by a participating physician or supplier, the beneficiary (or the person authorized to request payment on the beneficiary's behalf) is not required to assign the claim to the supplier in order for an assignment to be effective.
(d) For purposes of claims for services submitted by an MDPP supplier (as defined at § 410.79(b) of this chapter), Medicare deems such claims to have been assigned by the beneficiary (or the person authorized to request payment on the beneficiary's behalf) and the assignment accepted by the MDPP supplier.
[53 FR 6634, Mar. 2, 1988, as amended at 63 FR 20130, Apr. 23, 1998; 69 FR 66426, Nov. 15, 2004; 82 FR 53364, Nov. 15, 2017]