Medicare pays the beneficiary for the following services, if covered, in the specified circumstances:
(a) Emergency inpatient and outpatient services furnished by a nonparticipating U.S. hospital that has not elected to claim payment in accordance with subpart G of this part.
(b) Certain medical and other health services covered under Medicare Part B and furnished by a nonparticipating U.S. hospital, if the hospital does not receive assigned payment as a supplier under § 424.55.
(c) Emergency or nonemergency services furnished by a foreign hospital if the hospital does not have in effect an election to claim payment in accordance with subpart H of this part.
(d) Physician and ambulance services furnished outside the United States.
(e) Services furnished by a supplier if the claim has not been assigned to the supplier.
Notes of Decisions
Cong. of California Seniors v. Catholic Healthcare West, 2001 Cal. Daily Op. Serv. 1713 (Cal. Ct. App. 2001).
“) 8 Unlike Part A beneficiaries, Medicare Part B beneficiaries may receive direct payment from Medicare or assign their benefits to their treating physician or supplier ( 42 C.F.R. §§ 424.53 , 424.55) but Part B providers who accept assignments may not charge a beneficiary more…”
Courtney v. Choplin, 195 F. Supp. 2d 649 (D.N.J. 2002).
“§ 1395u(b)(3)(B); 42 C.F.R. §§ 424.53 , 424.55. When a physician accepts a patient beneficiary’s assignment of his claim for Medicare benefits, the physician assumes the responsibility for submitting a claim for reimbursement to the carrier for any medical services provided.”
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