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The Health Maintenance Organization Act 1973 required most employers to offer HMO coverage to their employees as an alternative to traditional heath insurance.
If a primary care physician sends a patient to a specialist for consultation and the specialist is nor in the managed care plan, the specialist may bill the primary care physician for payment.
The assignment on a patient with medicare-medicaid must always be accept or medicaid will not pick up the residental
When CMS-1500 claim form is automatically transferred by Medicare to a Medigap carrier, there is no need to abtain a separate signature authorization for the Medigap carrier.
Medicare provides insurance for disabled individuals if they have recieved Social Security disability benefits for 24 months.
All persons age 65 who meet elgibility requirements for Medicare recieve Medicare Part B (outpatient coverage).
Once a outpatient changes from Medicare to a senior HMO, the patient must stay with that HMO for the remainder of the calender year.
In a point of service (POS) program, members may choose to use a nonprogram provider at the time.
In certain managed care plans there is an incentive for the gatekeeper to limit patient referrals to specialists.
Medicare transmits Medigap claims electronically for participating physicians when medigap information is provided on the oringinal Medicare claim.
In the Medicare program, a physical examination is covered benefit when preformed within 12 months of enrollment.
The term "turfing" means to tranfer the sickest high-cost patients to other physicians so that the provider appears as low utilizer.
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