What happens to the individual physicians when the HMO terminates a contract with the group practice?
Some of the individual physicians will write an individual contract with the HMO. In this instance, the HMO pays the physician for each office encounter. The costs for such things as labs, x-rays, and specialists services are part of the risk that is assumed by the HMO, not the group practice. In this situation, the HMO is really at risk of losing money if the patient(s) require more services than is reimbursed by Medicare. The risk is not transferred to the individual practice. 23. Tell us more about problems with physicians who accept patients who are on Medicare fee for service. Physicians are finding that based upon the Medicare payment scale, the cost of treating Medicare clients is greater than they receive from Medicare. For example, the physician’s office must submit the paperwork to Medicare. If the paperwork is submitted incorrectly (such as improper codes) or Medicare does not believe a procedure is medically necessary, in order to be reimbursed, the physician’s office must
