Medicare Managed Care Manual (Pub. 100-16), Ch. 18b § 30.1
Payment by HCPP on Other Than Fee-For-Service Basis
30.1- Payment by HCPP on Other Than Fee-For-Service Basis
(Rev. 30, 09-05-03)
• If the HCPP pays a physician group on other than a fee-for-service basis, and that
physician group does not pay its physicians on a fee-for-service basis, costs are
considered reasonable if they:
o
Do not exceed those that a prudent and cost conscious buyer would incur
to purchase those services; and
o
Are comparable to costs incurred for similar services furnished by similar
physicians or other suppliers in the same or similar geographic area.
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