Fee-For-Service (FFS) System Final Settlement With the Provider

60 - Fee-For-Service (FFS) System Final Settlement With the Provider (Rev. 4, 10-01-01) In making final settlement with the provider, the FFS system will treat services furnished to Medicare HMO/CMP enrollees under arrangement as if the services were furnished to non-Medicare patients. The provider will be paid for such services under the terms of its arrangement with the organization, and payment to the provider might not be limited to cost. However, payment to the HMO/CMP for such services will be limited to the amount the FFS system would have paid the provider for furnishing the services. (See 42 CFR 417.548(a) for an exception to this rule.)