2005 CFR Title 42, Volume 2

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