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US · guidance

CMS Pub. 100-16, ch. mc86c17a, § 20.2.2

Final Settlement Payment for Medicare Cost-Based

activein force · 2026-08-25 – presentas-observed

HMO/CMPs

(Rev. 4, 10-01-01)

If the final settlement determination is greater than payments already made to the

HMO/CMP through monthly capitation payments and interim settlement, an

underpayment will be declared, and CMS will make a lump-sum payment to the

HMO/CMP.

Conversely, if the final settlement determination is less than the total payment made, the

HMO/CMP has been overpaid, and CMS must recover the overpayment.

History

(Rev. 4, 10-01-01)

Provenance

Source
cms.gov
Retrieved
2026-08-25
Edition
iom-2026-08-25
Content hash
00507906640b688796482660fcbb99d0a97fcff6be3a1cf991445be165434091
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