hmo

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    Wiki Opt out of HMO

    I work at a physical therapy clinic who (thought) we only took PPO insurances. Now, we find out (after a call and a dig through one of our contracts) that one of our insurances looped us into their 'complete' contract (PPO, EPO, HMO, etc.). I recently remember reading that their was a legal...
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    Wiki Lucentis Injections

    Hello Everyone, My administrator has asked me to verify payment of a Lucentis Injection for a patient who has a MediCal HMO. The facility has an authorization for the procedure, which includes the J2778, as well as the 67028. The IPA for the HMO is stating as long as I have the approval, it...
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    Wiki Contracted Rates with HMOs for Medicare Patients

    Can anyone tell me if a participating Medicare provider is prohibited by CMS to be contracted with an HMO at greater than 100% of Medicare's allowed amount? (specifically for Medicare patients that have an HMO) I know this pertains more to the billing side of things but I am not finding an...
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