Medicare Managed Care Manual (Pub. 100-16), Ch. 17b § 230
Limitation on Payment
230 - Limitation on Payment
(Rev. 4, 10-01-01)
Unless otherwise specified, the payment limitations imposed on the amounts payable to
providers of services (and other health care facilities) under Medicare reimbursement
principles apply to amounts payable for covered services furnished by:
•
Providers of services owned and operated by a cost-based HMO/CMP;
•
Providers related to a cost-based HMO/CMP by common ownership or control; or
•
Providers or other health care facilities which furnish services that are paid on a
reasonable cost basis.
The payment limitations applicable to cost-based HMO/CMPs include (but are not
limited to) those described in §§250 through 300.