When is a physician-hospital organization (PHO) required to pay the surcharge on payments it makes to its member acute hospitals or ambulatory surgical centers?
A PHO that contracts with an HMO, PPA, commercial insurer, or Blue Cross plan, and then allocates revenues received among its members, is considered to be acting as a provider representative and does not have to pay the surcharge. A PHO that contracts with another entity, such as a self-insured plan or directly with an employer, and then allocates revenues to its members, must pay the surcharge on revenues transferred from the PHO to acute hospitals or ASCs. A list of PHOs and their Tax ID Numbers is included on the Division’s Hospital and Ambulatory Surgical Center Tax ID Numbers List.
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