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At least 307 records · Page 17Linked to original sources
PubMed1997

Medicare and Medicaid HMO incentive plan rules change.

Physicians and physician groups that participate in incentive plans offered by Medicare and Medicaid HMOs may be affected by a change in the rules pertaining to such plans. The change, which became effective January 1, 1997, sets a threshold percentage for substantial risk sharing for referral services; obliges HMOs to conduct annual enrollment surveys; and requires HMOs that contract with physician groups that serve 25,000 or fewer patients to obtain stop-loss protection. In addition to these rule changes, Medicare and Medicaid HMOs are now required to disclose information about physician incentive plans to Medicare and Medicaid beneficiaries who request it and report changes in incentive plans to HCFA at least 45 days before they take effect. Physicians should familiarize themselves with the changes pertaining to incentive plans to ensure that the Medicare and Medicaid HMOs with which they contract are in compliance and that they do not assume an excessive degree of financial risk for referral services.

Group Practice, Prepaid↗
PubMed1990

Medicare program; definition of surgical services--HCFA. Notice of definition of surgical services for physician volume performance standard rates for increase with comment.

This notice announces the definition of surgical services for purposes of the performance standard rates of increase for expenditures and volume of physician services and the appropriate fee schedule updates under the Medicare Supplementary Medical Insurance (Part B) program as required by section 6102 of the Omnibus Budget Reconciliation Act of 1989 (Pub. L. 101-239). Surgical services are defined as follows: All services currently classified as type of service "surgery" in the Medicare payment record that are performed by surgical specialists, including podiatrists and oral surgeons. All services currently classified as type of service "assistant at surgery" in Medicare payment records. This definition includes procedures recognized in the surgical section of Current Procedural Terminology published by the American Medical Association and certain other invasive procedures. This definition would not lead to payment differentials by physician specialty. Any differential in annual updates because of separate performance standard rates would be procedure-specific without regard to specialty.

Centers for Medicare and Medicaid Services, U.S.↗