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Printed Date: 9/22/2015
Medicare cannot make payment for covered items or services when payment has been made or can reasonably be expected to be made promptly by auto medical/no-fault or liability insurance.
The Omnibus Budget Reconciliation Act of 1986 (OBRA 1986) provides that any claimant has the right to take legal action against an auto medical, no-fault or liability insurer that fails to pay primary benefits for services covered by the insurer and to collect double damages.
Medicare processing guidelines include the following instructions for each type.
In addition, Medicare guidelines state that providers (except reference labs) are required to ask Medicare patients, or their representatives, at admission or start of care, if the services are for treatment of an injury or illness which resulted from an automobile accident or other incident, including one that occurs on the provider's premises, for which he or she holds another party responsible.
CMS Regulation Reference: Publication 100-05, Chapter 1 (PDF, 191 KB)
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Last Updated: 03/28/2019