Payment for Services Provided Under a Contractual Arrangement - Carrier Claims Only (Rev. 472, Issued: 02-11-05)

by  Find-A-Code
July 17th, 2015

A carrier may make payment to an entity (i.e., a person, group, or facility) enrolled in the Medicare program that submits a claim for services provided by a physician or other person under a contractual arrangement with that entity, regardless of where the service is furnished. Thus, the service may be furnished on or off the premises of the entity submitting the bill and receiving payment. The entity receiving payment and the physician or other person that furnished the service are both subject to the following program integrity safeguard requirements:

1. The entity receiving payment and the person that furnished the service are jointly and severally responsible for any Medicare overpayment to that entity; and,

2. The person furnishing the service has unrestricted access to claims submitted by an entity for services provided by that person.

Pub 100-04 Medicare Claims Processing Manual

References:

Payment for Services Provided Under a Contractual Arrangement - Carrier Claims Only (Rev. 472, Issued: 02-11-05). (2015, July 17). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/payment-for-services-provided-under-a-contractual-arrangement-carrier-claims-only-rev-472-issued-02-11-05-27259.html

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