The Medicare HMO/CMPs’ Obligations

300.2 - The Medicare HMO/CMPs’ Obligations (Rev. 4, 10-01-01) When the Medicare program is not the primary payer for covered Medicare services provided to Medicare members of an HMO/CMP, the organization must: • Identify payers that are primary to Medicare under §1862(b) of the Act; • Determine the amounts payable by these payers; and • Take steps in accordance with these instructions and the instructions in §§3407-3419 and §§3489-3492 of the Medicare Intermediary Manual to assure that Medicare pays only secondary benefits when another insurer is primary payer. In addition, in situations when the cost-based HMO/CMP may charge another HMO/CMP or the Medicare beneficiary for services when Medicare is not primary payer, it may also require the enrollee to sign a subrogation agreement under which the HMO/CMP is given the rights the beneficiary has against the third party.