Action if Payment Has Been Made Under No-Fault Insurance

40.2.1 - Action if Payment Has Been Made Under No-Fault Insurance (Rev. 11550; Issued: 08-12-22; Effective: 10-13-22; Implementation:10-13-22) If the A/B MAC and DME MAC is aware when processing a Medicare claim that payment has been made either to the provider, physician, or to the beneficiary under no-fault insurance, or there is an open ORM record on CWF, the A/B MAC and DME MAC denies the claim. However, a Medicare secondary payment may be made if the no-fault insurer paid less than the full physician's charge and the physician is not obligated to accept the payment as payment in full if no ORM record on CWF or ORM benefits have been exhausted. If A/B MACs and DME MACs learn after Medicare benefits were paid that payment was also made by a no-fault insurer, the excess Medicare benefits are subject to recovery in accordance with the Pub. 100-05, Chapter 7, Section 20.8 states when a physician is liable for refunding the primary Medicare payments. The beneficiary is liable in all other situations as cited in Section 20.9.