42 CFR 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).
(2) To limit charges to the beneficiary or any other source as follows:
(ii) To collect only the difference between the Medicare approved amount and the Medicare Part B payment (for example, the amount of any reduction in incurred expenses under § 410.155(c), any applicable deductible amount, and any applicable coinsurance amount) for services for which Medicare pays less than 100 percent of the approved amount.
(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.
Title 42 published on 2015-10-01
The following are ALL rules, proposed rules, and notices (chronologically) published in the Federal Register relating to 42 CFR Part 424 after this date.
- 42 CFR 405.504 — Determining Prevailing Charges.
- 42 CFR 417.800 — Payment to HCPPs: Definitions and Basic Rules.
- 42 CFR 405.520 — Payment for a Physician Assistant's, Nurse Practitioner's, and Clinical Nurse Specialists' Services and Services Furnished Incident to Their Professional Services.
- 42 CFR 416.30 — Terms of Agreement With CMS.
- 42 CFR 405.902 — Definitions.