Medicare Managed Care Manual (Pub. 100-16), Ch. 18b § 10

Physician Services - General

Last amended: 2003Year: 2003Length: 102 wordsOfficial source
10 - Physician Services - General (Rev. 30, 09-05-03) Amounts paid by a Health Care Prepayment Plan (HCPP) for physicians' services are allowable to the extent they are reasonable. Different tests of reasonableness apply, depending upon whether the organization employs the physicians directly or pays for physicians' services on a fee-for-service basis or some other basis. The allowability of physician and other Part B supplier services furnished directly is determined in accordance with §20 of this subchapter. The allowability of physician and other Part B supplier services furnished under arrangements is determined in accordance with the provisions of §30 of this subchapter.
Medicare Managed Care Manual (Pub. 100-16), Ch. 18b § 10: Physician Services - General | Justis AI