Applications of Deductible and Coinsurance in Liability and

20.4.1 - Applications of Deductible and Coinsurance in Liability and Indemnification Situations (Rev. 12, Issued: 10-22-04, Effective: 04-01-05, Implementation: 04-04-05) Under 1879 of the Act, a beneficiary is not responsible for payment of the Part B deductible or coinsurance for items or services that are neither reasonable and necessary to diagnose or treat the illness or injury, nor to improve the functioning of a malformed body member. If the provider knew, or should have known, that Medicare considered such services medically unnecessary, but failed to inform the beneficiary before furnishing them, the provider is held liable for their cost. If the beneficiary made payment for such items or services, he/she can be indemnified for them. In most cases, however, funds can be collected while awaiting the outcome of review of a demand bill for institutional services-- See Publication 100-04, Chapter 1, §60.3, See §60.3.1 in the same chapter for specific information on limitations on collecting funds from beneficiaries in SNF Part A stays. In general, see Chapter 30 of that publication for information on limitation of liability.