Cost-Based HMO/CMP Services Furnished Non-Enrolled Medicare

20 - Cost-Based HMO/CMP Services Furnished Non-Enrolled Medicare Patients (Rev. 4, 10-01-01) The HMO/CMP may furnish services to Medicare beneficiaries who are not enrolled in the HMO/CMP’s prepayment plan. Since the contract with CMS is limited to Medicare beneficiaries actually enrolled in the HMO/CMP, the cost apportionment process distinguishes between Medicare enrollees of the HMO/CMP and non-enrolled Medicare patients. For services furnished Medicare patients not enrolled in the HMO/CMP, Medicare payment is made through the Part A intermediary or Part B carrier, outside the scope of the cost-based HMO/CMP contract with CMS.