C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 411—EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT › Subpart B—Insurance Coverage That Limits Medicare Payment: General Provisions

42 C.F.R. § 411.31

Authority to bill primary payers for full charges

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(a) The fact that Medicare payments are limited to the DRG amount, or the reasonable charge, reasonable cost, capitation or fee schedule rate, does not affect the amount that a primary payer may pay.

(b) With respect to workers' compensation plans, no-fault insurers, and employer group health plans, a provider or supplier may bill its full charges and expect those charges to be paid unless there are limits imposed by laws other than title XVIII of the Act or by agreements with the primary payer.

Notes of Decisions
Cited in 4 cases (1 in the last 5 years), 1998–2021 · leading case: Gist v. Atlas Staffing, Inc.
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Gist v. Atlas Staffing, Inc. (2018) minn “See 42 C.F.R. § 411.31 (b) (2016) ("With respect to workers' compensation plans .”
Cooper Hospital University Medical Center v. Selective Insurance Company of America (085211) (Camden County and Statewid (2021) nj “See 42 C.F.R. § 411.31 (b) (“With respect to .”
MSP Recovery Claims, Series LLC v. New York Central Mutual Fire Insurance Company (2019) nynd “at ¶¶ 10, 11; see also 42 C.F.R. § 411.31 . Finally, Plaintiffs claim that Defendant reported to the Centers for Medicare and Medicaid Services ("CMS") that it was the primary payer for R.”
Smith v. Farmers Insurance Exchange (1998) coloctapp · cites it 2× “” 42 C.F.R. §411.31 (b) (1997) provides in pertinent part: With respect to .”
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