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Saturday, May 2, 2020 | History

6 edition of Medicare provider-sponsored organizations found in the catalog.

Medicare provider-sponsored organizations

a practical guide to development and certification

by Peter N. Grant

  • 347 Want to read
  • 2 Currently reading

Published by AHA Press in Chicago, Ill .
Written in English

    Places:
  • United States.
    • Subjects:
    • Medicare.,
    • Provider-sponsored organizations (Medical care) -- United States.

    • Edition Notes

      StatementPeter N. Grant, W. Reece Hirsch.
      ContributionsHirsch, William Reece.
      Classifications
      LC ClassificationsRA412.3 .G7 1998
      The Physical Object
      Paginationxii, 66 p. ;
      Number of Pages66
      ID Numbers
      Open LibraryOL366847M
      ISBN 101556482434
      LC Control Number98027335
      OCLC/WorldCa39275838

      Provider Sponsored Organizations (PSOs) and Preferred Provider Organizations (PPOs) that are not organized under the laws of a state and are neither a federally qualified HMO or CMP are not eligible to contract with Medicare under the risk contract program. The General Assembly further declares that, because provider sponsored organizations provide health care directly and assume responsibility for the provision of health care services to Medicare beneficiaries under the requirements of the federal Medicare program, they require different regulatory oversight to protect the public than health.


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Medicare provider-sponsored organizations by Peter N. Grant Download PDF EPUB FB2

Additional Physical Format: Online version: Grant, Peter N. Medicare provider-sponsored organizations. Chicago, Ill.: AHA Press, © (OCoLC) Provider Sponsored Organizations: A Golden Opportunity in Medicare Managed Care Physicians and other providers will soon have a chance to bypass the middleman and compete in managed by: 2.

APPLICATION FOR CERTIFICATE OF AUTHORITY MEDICARE PLUS CHOICE PROVIDER SPONSORED ORGANIZATIONS (PSO) This package is designed to assist individuals in preparing the application with all the information required by statute and to facilitate expeditious processing of the application by this Office.

As providers become more adept at managing large amounts of risk, they become interested in organizing health plans, such as PSOs (see Hirshfield, Edward, Α Provider Sponsored Organizations and Provider-Service Networks - Rationale and Regulation, ≅ American Journal of Law and Medicine, vol xii, Nos.

2 and 3,p. Get this from a library. Medicare provider-sponsored organizations: hearing before the Subcommittee on Health of the Committee on Ways and Means, House of Representatives, One Hundred Fifth Congress, first session, Ap [United States.

Congress. House. Committee on Ways and Means. Subcommittee on Health.]. Find many great new & used options and get the best deals for J-B AHA Press: Medicare Provider-Sponsored Organizations: A Practical Guide to Development and Certification by Peter N.

Grant and William Reece Hirsch (, Paperback) at the best online prices at. PSO (Provider-Sponsored Organization) A Provider-Sponsored Organization (PSO) is a type of managed care plan that is operated by a group of doctors and hospitals that form a network of providers within which you must stay to receive coverage for your care.

People with Medicare can choose to get their Medicare benefits through a PSO. This type of plan is not available in most parts of the country. After provider-sponsored plans became widespread in the s and s, a few organizations' plans have stood the test of time: Kaiser Permanente in Oakland, Calif., Danville, Pa.-based Geisinger.

Traditional Medicare is a fee for service plan. With Medicare Advantage, you have a choice of coverage options. You can choose from different types of plans. These include Medicare HMO’s, Medicare Preferred Provider Organizations or PPO’s, Provider Sponsored Organizations (PSO), Private Fee for Service Plans (PFFS).

Provider Sponsored Organizations: A Golden Opportunity in Medicare Managed Care Physicians and other providers will soon have a chance to bypass the middleman and compete in managed Medicare. Definitions for provider-sponsored organizations.

provider-sponsored organizations. Medicare Advantage: Sometimes called Medicare Part C (formerly Medicare + Choice), you'll get in-depth explanations of the expanded range of choices potentially available to Medicare beneficiaries including provider-sponsored organizations, private fee-for-service plans, and medical savings accounts.

Medicare to other types of managed care organizations (for example, preferred provider organizations and provider-sponsored organizations), private fee-for-service plans, and, on a limited demonstration basis, high deductible plans (called medical savings account plans) offered in conjunction with medical savings accounts (effective on enactment).

Local PPOs - A local PPO has a service area that is specified by the organization offering the plan and approved by CMS.

Its service area typically will consist of one or multiple counties. However, as noted in Chapter 4 of the Medicare Managed Care. Methodology The National Directory of Managed Care Organizations is drawn from a database containing more than 1, MCOs, pharmacy benefit management companies and pharmacy networks, and 28 PSOs operating under the Medicare+Choice Demonstration : Paperback.

"Section Payments to Medicare+Choice Organizations" "Section Premiums" "Section Organizational and Financial Requirements for Medicare+Choice Organizations; Provider Sponsored Organizations" "Section Establishment of Solvency Standards" Medicare Capital Asset Sales Price Equal to Book Value.

The book serves as a practical guide for hospital and health system executives considering, or in the early stages of, implementing a provider-sponsored health plan (PSHP) for their organizations.

Medicare Advantage: Sometimes called Medicare Part C (formerly Medicare + Choice), you'll get in-depth explanations of the expanded range of choices potentially available to Medicare beneficiaries including provider-sponsored organizations, private fee-for-service plans, and medical savings : $   Preferred provider organizations are a type of health plan.

PPOs have a network of doctors, hospitals, and other providers who have agreed to charge less for plan members. Provider sponsored organizations: emerging opportunities for growth.

Fine A(1), Dowd CE. Author information: (1)Ernst & Young, Chicago, IL, USA. As providers struggle to identify mechanisms to serve the Medicare population, the Medicare program continues to : Fine A, Dowd Ce.

Provider Sponsored Organizations. The Maryland Certificate of Authority for health maintenance organizations, limited health service organizations, and provider sponsor organizations expires annually on November The Certificate of Authority should be renewed online between November 1 and November 30 in accordance with § (b) of the.

State Regulatory Experience with Provider-Sponsored Organizations. 06/27/ Many PSOs serve Medicare risk enrollees downstream from licensed managed care organizations, and are therefore wary of legislation that could negatively affect current Medicare risk contractors.

We analyzed the financial and market performance of provider-sponsored managed care organizations (MCOs) during – The two parts of our analysis included: Financial benchmarking to identify top financially performing PSPs and benchmark their performance across lines of business (Medicare Advantage, Medicaid, and commercial) and.

Provider-sponsored health plans Positioned to win the health insurance market shift i An MCO’s core LOB is the LOB with the greatest enrollment share as a percentage of the MCO’s total enrollment.

Executive summary If you search for a list of area health plans offering insurance coverage, chances are good that you may see your health. The initial reaction to a new category of contractors for Medicare risk contracts, Provider Sponsored Organizations (PSOs), was one of optimism that this would become an opportunity to assume the insurance function and thereby increase revenues (Hospitals & Health Networks ).File Size: 69KB.

Purpose: The author describes new options in Medicare plans. The Medicare + Choice program that includes HMOs, medical savings accounts (MSA), provider sponsored organizations (PSO), private fee for service plans (PFFS), and other types of plans included in The Balanced Budget Act (BBA) of are : Jennifer Marx.

Advantage plans, start-ups, provider-sponsored plans, delivery systems, technology companies, state and local governments, research foundations, and advocacy organizations to develop successful strategies amid shifting policies and priorities. In addition to. Provider Sponsored Organizations: Emerging Opportunities for Growth by Allan Fine, Colleen E.

Dowd,available at Book Depository with free delivery Insurer > Provider-sponsored organizations The Maryland Certificate of Authority for health maintenance organizations, limited health service organizations, and. Act.

Medicare + Choice allows Medicare beneficiaries to opt out of the traditional fee-for service Medicare program into health maintenance organizations (HMOs), preferred provider organizations (PPOs), provider-sponsored organizations, and other forms of managed care ORGANIZATIONAL AND FINANCIAL REQUIREMENTS FOR MEDICARE+CHOICE ORGANIZATIONS; PROVIDER–SPONSORED ORGANIZATIONS.

Sec. [42 U.S.C. w–25] Organized and Licensed Under State Law.—In general.— Subject to paragraphs (2) and (3), a Medicare+Choice organization shall be organized and licensed under State law as a risk—bearing entity eligible to offer.

Medicare provider-sponsored organizations: opportunities and challenges. DeParle NA(1). Author information: (1)Health Care Financing Administration, Washington, D.C., USA. PMID: [Indexed for MEDLINE] MeSH terms.

Capitation Fee; Health Maintenance Organizations; Hospital-Physician Joint Ventures/economics*Cited by: 1. Decem - Provider-sponsored health plans (PSHPs) are seen as a way for provider organizations to compete with commercial payers while lowering.

MEDICARE PLUS CHOICE PROVIDER SPONSORED ORGANIZATIONS (PSO) This package is designed to assist individuals in preparing the application with all the information required by statute and to facilitate expeditious processing of the application by this Office. PLEASE NOTE: THE COMPLETED CHECK LIST MUST BE SUBMITTED WITH THE APPLICATION PACKAGE.

provider sponsored organization (pso) A group of doctors, hospitals, and other health care providers that agree to give health care to Medicare beneficiaries for a set amount of. For example, accountable care organizations (ACOs) that are part of the Medicare Shared Savings Program (MSSP) are evaluated along a number of domains, including care coordination, preventive health, at-risk population care, and patient/caregiver experience.

In this last domain, there are six important variables. A provider-sponsored organization (PSO) is a managed care contracting and delivery organization consisting of a group of doctors, hospitals, and other health care providers who accept full risk for beneficiaries' lives.

Therefore, PSO provides its services in return for a fixed payment per month for each medicare beneficiary assigned to it. Congressional efforts to enable provider networks to contract directly with Medicare or Medicaid recipients culminated in the Medicare provider-sponsored organizations (PSO) provisions of the Balanced Budget Act ofsubject to guidelines to be developed by the.

Abstract. Purpose: The aim of this study was to assess the performance of health plans sponsored by provider organizations, with respect to plans generating strong positive cash flow relative to plans generating weaker cash flow.

A secondary aim was to assess their capital adequacy. Design: The study identified 24 provider-sponsored health plans (PSHPs) with an average positive cash flow. Generally, a Medicare health plan: Is offered by a private company. Contracts with Medicare to provide Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) benefits.

Provides these benefits to people with Medicare who enroll in the plan. Medicare health plans include: Medicare Advantage Plans.

Other Medicare health plans. The BBA expanded the program to include preferred provider organizations (PPOs), provider sponsored organizations (PSOs), point-of-service plans. Medicare Advantage: Sometimes called Medicare Part C (formerly Medicare + Choice), youll get in-depth explanations of the expanded range of choices potentially available to Medicare beneficiaries including provider-sponsored organizations, private fee-for-service plans, and medical savings accounts.

Medicare Advantage Organizations may agree to operate coordinated care plans (as defined in 42 CFR (a)(1)) so long as they do so in compliance with the requirements of their contract and applicable Federal statutes, regulations, and policies.Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are HMOs may include different models of HMOs including staff model, group model, or network model HMOs.

Provider-sponsored organizations —similar to HMOs, PSOs are organized and operated by physicians and hospitals. They provide most services within their organized.

H.R. (th). To amend title XVIII of the Social Security Act to provide for offering the option of Medicare coverage through qualified provider-sponsored organizations (PSOs), and for other purposes.

Ina database of bills in the U.S. Congress.