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Some HMOs pay gatekeeper PCPs set fees for each defined medical procedure they provide to insured patients (fee-for-service) and then capitate specialists (that is, pay a set fee for each insured person's care, irrespective of which medical procedures the specialists performs to achieve that care), while others use the reverse arrangement.
The Health Maintenance Organization Act of 1973 (Pub. L. 93-222 codified as 42 U.S.C. §300e) is a United States statute enacted on December 29, 1973. The Health Maintenance Organization Act, informally known as the federal HMO Act, is a federal law that provides for a trial federal program to promote and encourage the development of health maintenance organizations (HMOs).
Some suggest that the medical home mimics the managed care "gatekeeper" models historically employed by HMOs; however, there are important distinctions between care coordination in the medical home and the "gatekeeper" model. [24] [49] In the medical home, the patient has open access to see whatever physician they choose. No referral or ...
A health savings account (HSA) and a health maintenance organization (HMO) are both intended to help people cover the costs of medical care. However, they take very different approaches. HSAs are ...
Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) are both types of Medicare Advantage plans. ... 24/7 Help. For premium support please call: 800-290-4726 more ways ...
To help consumers navigate their options, ... This year, open enrollment for public health insurance plans begins Nov. 1, 2024, and closes on Jan. 15, 2025. During the open enrollment period ...
Health Insurance Portability and Accountability Act (1996) Medicare Prescription Drug, Improvement, and Modernization Act (2003) Patient Safety and Quality Improvement Act (2005) Health Information Technology for Economic and Clinical Health Act (2009) Patient Protection and Affordable Care Act (2010)
In practice, an HMO is a coordinated delivery system that combines both the financing and the delivery of health care for enrollees. In the design of the plan, each member is assigned a "gatekeeper", a primary care physician (PCP) responsible for the overall care of members assigned. Specialty services require a specific referral from the PCP ...