[Code of Federal Regulations]
[Title 42, Volume 2]
[Revised as of October 1, 2002]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR424.80]

[Page 951-952]
 
                         TITLE 42--PUBLIC HEALTH
 
                             HUMAN SERVICES
 
PART 424--CONDITIONS FOR MEDICARE PAYMENT--Table of Contents
 
     Subpart F--Limitations on Assignment and Reassignment of Claims
 
Sec. 424.80  Prohibition of reassignment of claims by suppliers.

    (a) Basic prohibition. Except as specified in paragraph (b) of this 
section, Medicare does not pay amounts that are due a supplier under an 
assignment to any other person under reassignment, power of attorney, or 
any other direct arrangement.
    (b) Exceptions to the basic rule--(1) Payment to employer. Medicare 
may pay

[[Page 952]]

the supplier's employer if the supplier is required, as a condition of 
employment, to turn over to the employer the fees for his or her 
services.
    (2) Payment to a facility. Medicare may pay the facility in which 
the services were furnished if there is a contractual arrangement 
between the facility and the supplier under which the facility bills for 
the supplier's services.
    (3) Payment to health care delivery system. Medicare may pay a 
health care delivery system if there is a contractual arrangement 
between the system and the supplier under which the system bills for the 
supplier's services.
    (4) Payment to a government agency or entity. Subject to the 
requirements of the Assignment of Claims Act (31 U.S.C. 3727), Medicare 
may pay a government agency or entity under a reassignment by the 
supplier.
    (5) Payment under a reassignment established by court order. 
Medicare may pay under a reassignment established by, or in accordance 
with, the order of a court competent jurisdiction, if the reassignment 
meets the conditions set forth in Sec. 424.90.
    (6) Payment to an agent. Medicare may pay an agent who furnishes 
billing and collection services to the supplier, or to the employer, 
facility, or system specified in paragraphs (b) (1), (2) and (3) of this 
section, if the conditions of Sec. 424.73(b)(3) for payment to a 
provider's agent are met by the agent of the supplier or of the 
employer, facility, or system. Payment to an agent will always be made 
in the name of the supplier or the employer, facility, or system.
    (c) Rules applicable to an employer, facility, or system. An 
employer, facility, or system that may receive payment under paragraph 
(b)(1), (b)(2), or (b)(3) of this section will itself be considered the 
supplier of those services for purposes of the rules of subparts C, D, 
and E of this part.

[53 FR 6634, Mar. 2, 1988, as amended at 54 FR 4027, Jan. 27, 1989]