US · guidance
CMS Pub. 100-16, ch. 11, § 110.4.2
Prevention of Member Billing
The following procedures may help prevent member billing:
• Initiate internal audits of hold-harmless provisions in downstream provider
contracts;
• Provide written notification to all Medicare beneficiaries assigned to or receiving
care through insolvent provider groups instructing them not to pay bills (except
applicable copayments and or deductibles) for provider group obligations and to
forward any bills to the MA organization;
• Provide written notification to an insolvent group's downstream contractors
informing them that billing Medicare members for an insolvent group's
obligations is prohibited; and
• Develop and implement specific policies and procedures to prevent non-contracting providers from billing Medicare beneficiaries for insolvent provider
group obligations.
History
(Rev. 79, Issued 02-17-06, Effective Date 02-17-06)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
4185184356af52d40b9be0d257856f497bef8f074ac8cc85713441aaa61dcc36
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