The Funds is a Medicare Health Care Prepayment Plan (HCPP) and is the Medicare payer for non-facility Part B services, such as physician, laboratory, and ambulance services and medical equipment and supplies.
Providers must bill the Funds for Medicare Part B services. Medicare carriers will not pay for Part B services provided to Funds’ beneficiaries. The Funds payment to the provider will include the Medicare amount plus the Medicare coinsurance and deductible amount, making it unnecessary for the provider to submit claims to two payers.
Health care providers should bill charges for Medicare Part A services and other services normally paid by the Medicare fiscal intermediary directly to the intermediary. In general, Medicare Part A covers hospital care, skilled nursing facility care, nursing home care (as long as custodial care isn’t the only care you need), hospice and home health services. After payment by the fiscal intermediary the provider may bill the Funds for Medicare coinsurance and deductibles.
