Payment Procedures for Provider Services Paid for Directly by the

20 - Payment Procedures for Provider Services Paid for Directly by the HMO/CMP (Rev. 4, 10-01-01) Unless the HMO/CMP elects to have CMS pay certain providers (hospitals and SNFs) directly for provider services, it is responsible for making payment directly to these providers. The payment to the HMO/CMP will be equivalent to what CMS’s Fee-For- Service (FFS) system would have paid for the service unless the organization demonstrates that additional payments are justified. (See Chapter 17.) Since certain additional work will be required by the provider in some cases, the organization must secure an agreement with the provider to accomplish all the things necessary to establish proper payment. Regardless of the billing option selected, all Medicare-covered services for which the HMO/CMP has financial liability are reviewed in the settlement process. (See §80.2 of Chapter 17, Subchapter A.)