Any compensation arrangement at any contracting level between a managed care organization (MCO) and a physician or physician group that may directly or indirectly have the effect of reducing or limiting services furnished to Medicare or Medicaid enrollees in the MCO. MCOs must disclose physician incentive plans between groups or intermediate entities (e.g., certain individual practice associations [IPAs], physician-hospital organizations [PHOs]) and individual physicians and groups.
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Physician licensing board
State organization responsible for issuing licenses, accreditation, or certification for a health care provider to practice. Also called Board of Healing Arts, Board of Medical Examiners, Board of Medical Practice, Department of Business and Professional Regulation, and medical licensing board.
physician management corporation (PMC)
See: management services organization (MSO).
physician organization (PO)
Association of physicians who contract with managed care plans as an entity or represent the physician part in a physician hospital organization (PHO). Physician practice financials are linked to assist physicians in managing risk and capitation.
Physician Payment Review Commission (PPRC)
See: Medicare Payment Advisory Commission (MedPAC or MedPac), which replaced PPRC.
physician practice management company (PPMC)
Business that is investor owned and purchases, partners, or manages physician practices and gives investment capital for development or expansion of a practice.
physician provider group (PPG)
A physician-owned business that has the flexibility to deal with all forms of contract medicine and still offer its own packages to business groups, unions, and the general public.
Physician Quality Reporting Initiative (PQRI)
Voluntary program that provided a financial incentive to physicians and other eligible professionals who successfully reported quality information related to services provided under the Medicare Physician Fee Schedule between July 1 and December 31, 2007. It was established when President Bush signed the Tax Relief and Health Care Act of 2006 (TRHCA), Section 101 Title I.
Physician services
Medical services rendered by a physician to a patient. This may include surgery, consultation, home visit, office visit, hospital visits, and institutional visits. Physician services given while in the hospital that appear on the hospital bill are not included.
Physician visits
In-hospital, office, and home face-to-face visits by a physician. Most health plans provide insurance payment for visits when a patient is ill or has been injured.