Model Terms and Conditions of Payment

50.2 - Model Terms and Conditions of Payment (Rev. 99, Issued: 05-27-11, Effective: 05-27-11, Implementation: 05-27-11) CMS annually issues a model terms and conditions of payment for PFFS plans for each contract year. CMS expects all full, partial, and non-network PFFS plans, including employer/union sponsored PFFS plans, to implement the model terms and conditions of payment for their deemed providers effective January 1 of the applicable contract year. Employer/union sponsored PFFS plans that operate on a non-calendar year schedule are expected to implement the model terms and conditions of payment effective the beginning of the plan’s applicable contract year. The model terms and conditions of payment provide a uniform format and content, which is of particular benefit to providers treating members of different PFFS plans. Use of the model also expedites review by CMS Regional Offices (ROs). Refer to section 50.3 of this chapter for more information. The model terms and conditions of payment are posted on the CMS website at http://www.cms.hhs.gov/PrivateFeeforServicePlans/.