Medicare Benefit Policy Manual (Pub. 100-02), Ch. 10 § 20.1.1

Managed Care Providers/Suppliers

Last amended: 2009Year: 2009Length: 139 wordsOfficial source
20.1.1 - Managed Care Providers/Suppliers (Rev. 103; Issued: 02-20-09; Effective Date: 01-05-09; Implementation Date: 03- 20-09) Mandatory assignment for ambulance services, in effect with the implementation of the ambulance fee schedule, applies to ambulance providers/suppliers under managed care as well as under fee-for-service. The ambulance fee schedule is effective for claims with a date of service on or after April 1, 2002. Any provider or supplier without a contract establishing payment amounts for services provided to a beneficiary enrolled in a Medicare Advantage (MA) coordinated care plan or MA private fee-for-service plan must accept, as payment in full, the amounts that they could collect if the beneficiary were enrolled in original Medicare. The provider or supplier can collect from the MA plan enrollee the cost-sharing amount required under the MA plan, and collect the remainder from the MA organization.
Medicare Benefit Policy Manual (Pub. 100-02), Ch. 10 § 20.1.1: Managed Care Providers/Suppliers | Justis AI