Medicare Managed Care Manual (Pub. 100-16), Ch. 17b § 140
Physician and Other Part B Supplier Services Furnished Under
140 - Physician and Other Part B Supplier Services Furnished Under
Arrangements
(Rev. 4, 10-01-01)
The amount the HMO/CMP pays to a physician, physician group, or supplier for
physician and other Part B supplier services furnished under arrangements is an allowable
cost to the extent it is reasonable. Costs are considered reasonable if they:
•
Do not exceed those that a prudent and cost conscious buyer would incur to
purchase those services; and
•
Are comparable to costs incurred for similar services furnished by similar
physicians or other suppliers in the same or similar geographic area.