MEDICARE AND MEDICAID PATIENTS. Manager and Group agree to generate such records and make such disclosures as may be required, from time to time, by the Medicare, Medicaid and other third party payment programs with respect to their participation in this Management Agreement and the rendition of services hereunder, in order to assure that both parties will be able to meet all requirements for participation and payment associated with such programs, including but not limited to the matters covered by Section 1861(v)(1)(I)
MEDICARE AND MEDICAID PATIENTS. All the information I gave when I applied for Medicare/Medicaid payment is correct. I request that payment of authorized Medicare benefits be made on my behalf to the above named Facility for any services furnished to me by them. I authorize any holder of medical information about me to release to The Centers for Medicare and Medicaid Services (CMS) and its agents any information needed to determine these benefits or the benefits payable for related services.
MEDICARE AND MEDICAID PATIENTS. The patient must agree NOT to seek reimbursement for the membership fees in this agreement from any health care plan, including Medicare or Medicaid. If the Patient submits membership fees for insurance reimbursement, this agreement will terminate immediately. However, Patients may use their insurance for payment of labs, diagnostic tests, radiology, medications, pathology, and other ancillary services provided by third parties outside Telehealth NP.
