US · guidance
CMS Pub. 100-04, ch. 30, § 100.6
Determining the Amount of Indemnification
In accordance with §1879(b) of the Act, the contractor indemnifies the beneficiary or
other person(s) for actual charges paid to a provider, practitioner, or supplier, rather than
the usual allowable charges as determined by the Medicare program, PPS amounts, or
established per diem rates that apply to certain provider, practitioner, or suppliers.
Additionally, §4096 of P.L. 100-203 (OBRA of 1987) revises certain limitation on
liability requirements for indemnification under §1879(b) of the Act. A beneficiary
qualifying for indemnification for denied items and services furnished on or after
January 1, 1988 is no longer responsible for paying deductible and coinsurance charges
related to the denied claim. Where such indemnification is made, the contractor may not
charge the beneficiary’s Medicare utilization record for the denied items and services
furnished.
History
(Rev. 1, 10-01-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
bae26b98210a7a1d770d187e6aaea9704e806dec210b7cb143bf9950e44ecbb7
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