对医疗保险的豁免和医疗保险支付限制

时间: 2009-05-20


2017-10-01

42 CFR 411

Exclusions from Medicare and limitations on Medicare payment

2018-07-12

Title 42--Public Health

CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES

PART 411--EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT


TEXT PDF 411.1 Basis and scope.
TEXT PDF 411.2 Conclusive effect of QIO determinations on payment of claims.
TEXT PDF 411.4 Services for which neither the beneficiary nor any other person is legally obligated to pay.
TEXT PDF 411.6 Services furnished by a Federal provider of services or other Federal agency.
TEXT PDF 411.7 Services that must be furnished at public expense under a Federal law or Federal Government contract.
TEXT PDF 411.8 Services paid for by a Government entity.
TEXT PDF 411.9 Services furnished outside the United States.
TEXT PDF 411.10 Services required as a result of war.
TEXT PDF 411.12 Charges imposed by an immediate relative or member of the beneficiary's household.
TEXT PDF 411.15 Particular services excluded from coverage.
TEXT PDF 411.20 Basis and scope.
TEXT PDF 411.21 Definitions.
TEXT PDF 411.22 Reimbursement obligations of primary payers and entities that received payment from primary payers.
TEXT PDF 411.23 Beneficiary's cooperation.
TEXT PDF 411.24 Recovery of conditional payments.
TEXT PDF 411.25 Primary payer's notice of primary payment responsibility.
TEXT PDF 411.26 Subrogation and right to intervene.
TEXT PDF 411.28 Waiver of recovery and compromise of claims.
TEXT PDF 411.30 Effect of primary payment on benefit utilization and deductibles.
TEXT PDF 411.31 Authority to bill primary payers for full charges.
TEXT PDF 411.32 Basis for Medicare secondary payments.
TEXT PDF 411.33 Amount of Medicare secondary payment.
TEXT PDF 411.35 Limitations on charges to a beneficiary or other party when a workers' compensation plan, a no-fault insurer, or an employer group health plan is primary payer.
TEXT PDF 411.37 Amount of Medicare recovery when a primary payment is made as a result of a judgment or settlement.
TEXT PDF 411.40 General provisions.
TEXT PDF 411.43 Beneficiary's responsibility with respect to workers' compensation.
TEXT PDF 411.45 Basis for conditional Medicare payment in workers' compensation cases.
TEXT PDF 411.46 Lump-sum payments.
TEXT PDF 411.47 Apportionment of a lump-sum compromise settlement of a workers' compensation claim.
TEXT PDF 411.50 General provisions.
TEXT PDF 411.51 Beneficiary's responsibility with respect to no-fault insurance.
TEXT PDF 411.52 Basis for conditional Medicare payment in liability cases.
TEXT PDF 411.53 Basis for conditional Medicare payment in no-fault cases.
TEXT PDF 411.54 Limitation on charges when a beneficiary has received a liability insurance payment or has a claim pending against a liability insurer.
TEXT PDF 411.100 Basis and scope.
TEXT PDF 411.101 Definitions.
TEXT PDF 411.102 Basic prohibitions and requirements.
TEXT PDF 411.103 Prohibition against financial and other incentives.
TEXT PDF 411.104 Current employment status.
TEXT PDF 411.106 Aggregation rules.
TEXT PDF 411.108 Taking into account entitlement to Medicare.
TEXT PDF 411.110 Basis for determination of nonconformance.
TEXT PDF 411.112 Documentation of conformance.
TEXT PDF 411.114 Determination of nonconformance.
TEXT PDF 411.115 Notice of determination of nonconformance.
TEXT PDF 411.120 Appeals.
TEXT PDF 411.121 Hearing procedures.
TEXT PDF 411.122 Hearing officer's decision.
TEXT PDF 411.124 Administrator's review of hearing decision.
TEXT PDF 411.126 Reopening of determinations and decisions.
TEXT PDF 411.130 Referral to Internal Revenue Service (IRS).
TEXT PDF 411.160 Scope.
TEXT PDF 411.161 Prohibition against taking into account Medicare eligibility or entitlement or differentiating benefits.
TEXT PDF 411.162 Medicare benefits secondary to group health plan benefits.
TEXT PDF 411.163 Coordination of benefits: Dual entitlement situations.
TEXT PDF 411.165 Basis for conditional Medicare payments.
TEXT PDF 411.170 General provisions.
TEXT PDF 411.172 Medicare benefits secondary to group health plan benefits.
TEXT PDF 411.175 Basis for Medicare primary payments.
TEXT PDF 411.200 Basis.
TEXT PDF 411.201 Definitions.
TEXT PDF 411.204 Medicare benefits secondary to LGHP benefits.
TEXT PDF 411.206 Basis for Medicare primary payments and limits on secondary payments.
TEXT PDF 411.350 Scope of subpart.
TEXT PDF 411.351 Definitions.
TEXT PDF 411.351 Definitions.
TEXT PDF 411.352 Group practice.
TEXT PDF 411.353 Prohibition on certain referrals by physicians and limitations on billing.
TEXT PDF 411.354 Financial relationship, compensation, and ownership or investment interest.
TEXT PDF 411.355 General exceptions to the referral prohibition related to both ownership/investment and compensation.
TEXT PDF 411.356 Exceptions to the referral prohibition related to ownership or investment interests.
TEXT PDF 411.357 Exceptions to the referral prohibition related to compensation arrangements.
TEXT PDF 411.357 Exceptions to the referral prohibition related to compensation arrangements.
TEXT PDF 411.361 Reporting requirements.
TEXT PDF 411.370 Advisory opinions relating to physician referrals.
TEXT PDF 411.372 Procedure for submitting a request.
TEXT PDF 411.373 Certification.
TEXT PDF 411.375 Fees for the cost of advisory opinions.
TEXT PDF 411.377 Expert opinions from outside sources.
TEXT PDF 411.378 Withdrawing a request.
TEXT PDF 411.379 When CMS accepts a request.
TEXT PDF 411.380 When CMS issues a formal advisory opinion.
TEXT PDF 411.382 CMS's right to rescind advisory opinions.
TEXT PDF 411.384 Disclosing advisory opinions and supporting information.
TEXT PDF 411.386 CMS's advisory opinions as exclusive.
TEXT PDF 411.387 Parties affected by advisory opinions.
TEXT PDF 411.388 When advisory opinions are not admissible evidence.
TEXT PDF 411.389 Range of the advisory opinion.
TEXT PDF 411.400 Payment for custodial care and services not reasonable and necessary.
TEXT PDF 411.402 Indemnification of beneficiary.
TEXT PDF 411.404 Criteria for determining that a beneficiary knew that services were excluded from coverage as custodial care or as not reasonable and necessary.
TEXT PDF 411.406 Criteria for determining that a provider, practitioner, or supplier knew that services were excluded from coverage as custodial care or as not reasonable and necessary.
TEXT PDF 411.408 Refunds of amounts collected for physician services not reasonable and necessary, payment not accepted on an assignment-related basis.

--------------------------------------------------------------------------------

[BACK ][BACK ]