Medicare Managed Care Manual (Pub. 100-16), Ch. 17a § 10.2
Bill Processing Options
10.2 - Bill Processing Options
(Rev. 4, 10-01-01)
A Medicare contract with CMS must state on an individual provider basis whether the
HMO/CMP elects:
•
To have CMS pay on the behalf of the HMO/CMP, hospitals and SNFs for
covered items and services furnished to the HMO/CMP's Medicare enrollees
(Option 1); or
•
To assume responsibility for paying some or all of these providers directly for
covered items and services furnished to the HMO/CMP's Medicare enrollees
(Option 2). Under this option, the HMO/CMP must specify each hospital and/or
SNF for which the HMO/CMP will assume the responsibility of paying for the
services rendered by that hospital or SNF.
The HMO/CMP must modify its contract with CMS for any changes in its election 90
days prior to the beginning of the contract period for which the change would be
effective. Regardless of the bill option elected, the HMO/CMP must comply with the
requirements in Chapter 17, Subchapter C.