Regulation about Medicare Advantage Payment Rates (Out of Contract)

 As I understand it, Medicare regulations do not tell MA plans they must pay Medicare rates, but they give providers rights to appeal UP TO Medicare rates, which the provider must accept as payment in full.  (Unless otherwise contracted).

In my understanding, by paying out of network providers Medicare rates, the MA plan avoids tying itself up in appeals on pricing which it would probably lose (unless it has clear evidence and testimony why the best rate is less than the CMS rate).

Previously, I've written,

"Medicare Advantage plans may contract with in-network provides at rates at, above, or below Traditional Medicare rates.  For out-of-network providers, Medicare provides some protection to Medicare Advantage plans, by requiring such providers to accept Traditional Medicare payment rates as payment-in-full.[FN] "   

Special rules for services furnished by noncontract providers.

(a) Services furnished by non-section 1861(u) providers. (1) Any provider (other than a provider of services as defined in section 1861(u) of the Act) that does not have in effect a contract establishing payment amounts for services furnished to a beneficiary enrolled in an MA coordinated care plan, an MSA plan, or an MA private fee-for-service plan must accept, as payment in full, the amounts that the provider could collect if the beneficiary were enrolled in original Medicare.

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[FN] https://www.gpo.gov/fdsys/pkg/CFR-2011-title42-vol3/xml/CFR-2011-title42-vol3-sec422-214.xml   42 CFR 422.214.