Billing and Collecting Fees for Professional Services. Practice, or each Participating Physician, shall submit claims to Medicare for services rendered to Model 4 Beneficiaries in the usual manner. Such claims shall be submitted on a weekly basis, but in any event within thirty (30) days of the provision of care. Practice and the Participating Physicians understand that the success of Model 4 depends in part on EIP having timely access to information regarding services provided to Model 4 Beneficiaries, and delays in submitting Part B claims to CMS may jeopardize the ongoing success of the program. Claims for services provided while the Model 4 Beneficiary is an inpatient at EIP during an Episode of Care will, however, be considered “no-pay” claims by Medicare (subject to the “opt out” provision set forth below). If a Part B no-pay claim is paid by Medicare for a Model 4 Beneficiary, the claim will be reprocessed by Medicare and payment will be recouped from the Practice or Participating Physician. EIP will receive a report each week from CMS of all of the no-pay claims associated with Model 4 at EIP. EIP will then process payment (through EIP’s contractor, EA Health) to Practice or its Participating Physicians at a rate equivalent to the amount that would have been paid for those services under the Medicare Physician Fee Schedule. Receipt of such payment shall be considered payment in full for services furnished by Practice or its Providers or Participating Physicians to Model 4 Beneficiaries during an Episode of Care. Payment will not be made under applicable Medicare FFS payment rules unless the Provider or Participating Physician has opted out of the Model 4 payment methodology in accordance with the process described below. Practice and its Participating Physicians and other Providers shall cooperate in the billing and claims payment process so that payment may be made in accordance with the Model 4 Agreement. Unassigned Part B claims are excluded from Model 4.
Billing and Collecting Fees for Professional Services. Practice, or each Participating Physician, shall be solely responsible for the billing and collection of professional fees for services rendered to MSSP Enrollees in connection with the Practice’s and Participating Physicians’ participation in the MSSP through the Network.
Billing and Collecting Fees for Professional Services. The Participant shall be solely responsible for the billing and collection of professional fees for services rendered to MSSP Enrollees in connection with the Participant’s participation in the MSSP through the Network.
Billing and Collecting Fees for Professional Services
