Medicare Managed Care Manual (Pub. 100-16), Ch. 18c § 20
HCPP Services Furnished Nonenrolled Medicare Patients
20 - HCPP Services Furnished Nonenrolled Medicare Patients
(Rev. 30, 09-05-03)
The HCPP may furnish services to Medicare beneficiaries who are not enrolled in the
HCPP's prepayment plan. Since the agreement with CMS is limited to Medicare
beneficiaries actually enrolled in the HCPP, the cost apportionment process distinguishes
between Medicare enrollees of the HCPP and nonenrolled Medicare patients. For
services furnished Medicare patients not enrolled in the HCPP, Medicare payment is
made through the Part A intermediary or Part B carrier, outside the scope of the cost-
based HCPP agreement with CMS.