US · guidance
CMS Pub. 100-16, ch. mc86c17c, § 20
Cost-Based HMO/CMP Services Furnished Non-Enrolled Medicare
Patients
(Rev. 4, 10-01-01)
The HMO/CMP may furnish services to Medicare beneficiaries who are not enrolled in
the HMO/CMP’s prepayment plan. Since the contract with CMS is limited to Medicare
beneficiaries actually enrolled in the HMO/CMP, the cost apportionment process
distinguishes between Medicare enrollees of the HMO/CMP and non-enrolled Medicare
patients. For services furnished Medicare patients not enrolled in the HMO/CMP,
Medicare payment is made through the Part A intermediary or Part B carrier, outside the
scope of the cost-based HMO/CMP contract with CMS.
History
(Rev. 4, 10-01-01)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
e3e7987d21497ba9e9ce04d81dec54de31eee73cfb2d1d1a3da35da11408ddad
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