[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR411.31]



[Page 388]

 

                         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

--Table of Contents

 

   Subpart B_Insurance Coverage That Limits Medicare Payment: General 

                               Provisions

 

Sec. 411.31  Authority to bill third party payers for full charges.



    (a) The fact that Medicare payments are limited to the DRG amount, 

or the reasonable charge, reasonable cost, capitation or fee schedule 

rate, does not affect the amount that a third party payer may pay.

    (b) With respect to workers' compensation plans, no-fault insurers, 

and employer group health plans, a provider or supplier may bill its 

full charges and expect those charges to be paid unless there are limits 

imposed by laws other than title XVIII of the Act or by agreements with 

the third party payer.