Prevention of Member Billing

110.4.2 - Prevention of Member Billing (Rev. 79, Issued 02-17-06, Effective Date 02-17-06) The following procedures may help prevent member billing: • Initiate internal audits of hold-harmless provisions in downstream provider contracts; • Provide written notification to all Medicare beneficiaries assigned to or receiving care through insolvent provider groups instructing them not to pay bills (except applicable copayments and or deductibles) for provider group obligations and to forward any bills to the MA organization; • Provide written notification to an insolvent group's downstream contractors informing them that billing Medicare members for an insolvent group's obligations is prohibited; and • Develop and implement specific policies and procedures to prevent non- contracting providers from billing Medicare beneficiaries for insolvent provider group obligations.