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