General Fee-For-Service (FFS) Coordination of Benefits Rules

140.3 - General Fee-For-Service (FFS) Coordination of Benefits Rules (Rev. 30, 09-05-03) All Medicare payments are contingent upon payment on reimbursement to the appropriate Trust Fund when notice or other information is received that payment for the 16 same items or services has also been made, or could be made, by a primary payer. Section 1862(b) of the Act now expressly provides that: • CMS may bring an action against any entity which is required or responsible to pay primary in order to recover Medicare payments directly from that entity; • The government is subrogated to the right of any individual or entity to receive payment from a responsible third party. Under the Medicare subrogation provision, the government is given whatever rights the beneficiary or any other entity had against the responsible third party to the extent that Medicare has made payments to or on behalf of the beneficiary; and • The government may join or intervene in any action related to the events that gave rise to the need for the items or services for which Medicare paid.