Medicare Managed Care Manual (Pub. 100-16), Ch. 18c § 40.1

Services Furnished Directly

Last amended: 2003Year: 2003Length: 144 wordsOfficial source
40.1 - Services Furnished Directly (Rev. 30, 09-05-03) The total allowable cost of Part B physician and supplier services (see Chapter 18, Subpart B, §§20) furnished directly shall be apportioned to Medicare on the basis of the ratio of covered Part B services furnished to Medicare enrollees to total services furnished to all the organizations' enrollees and nonenrolled patients. The HCPP must use a method for reporting costs and statistics that is approved by CMS. The CMS will base its approval on findings that the method: • Results in an accurate and equitable allocation of allowable costs; and • Is justifiable from an administrative and cost efficiency standpoint. For example, if the HCPP elects to use a relative value system to apportion costs, the HCPP must use the entire system as described by the designer of the system, and obtain CMS approval before implementation.
Medicare Managed Care Manual (Pub. 100-16), Ch. 18c § 40.1: Services Furnished Directly | Justis AI