Direct Payment by the HMO/CMP to Hospital and Skilled

10.2.1 - Direct Payment by the HMO/CMP to Hospital and Skilled Nursing Facilities (SNFs) (Rev. 4, 10-01-01) If the HMO/CMP elects to pay hospital and SNF providers directly for covered items and services (Bill Processing Option 2), the HMO/CMP must: • Determine the eligibility of the HMO/CMP's Medicare enrollees to receive covered items and services through the HMO/CMP; • Make proper coverage decisions and appropriate payments for covered items and services for which the HMO/CMP's Medicare enrollees are eligible; • Assure that these providers maintain and furnish appropriate documentation of physician certification and recertification, as required under Subpart B; 42 CFR, Part 424 (Certification and Plan of Treatment Requirements); and • Carry out any other procedures that CMS may require from time to time. CMS will determine whether the HMO/CMP has the experience and capability to efficiently and effectively carry out the responsibilities specified above.