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F M Prescott

Publications and source records attributed to F M Prescott.

7 recordsLinked to original sources
PubMed2000

Improve--rather than lose--your risk-taking entity.

When an HMO transfers financial risk to a provider risk-taking entity such as a physician-hospital organization (PHO), independent physician association (IPA), large medical group, or other provider contracting organization, it sometimes also transfers responsibility for administrative functions, such as claims processing. As a result, these providers risk financial problems related to medical costs, pricing, and underwriting strategies, as well as administrative efficiency. Financial managers should be aware of key indicators and processes that identify such problems to be able to take action before losses occur.

Cost Control↗
PubMed1997

PSNs: a new model for Medicare risk contracting.

The 1995 Republican House Medicare reform proposal introduced the provider services network (PSN) concept as a new healthcare delivery model for accepting and administering Medicare risk contracts. A PSN operates much like an HMO, but is not subject to the reserve requirements established for HMOs. Providers that want to enter the Medicare risk contracting arena and exercise more control over the delivery of healthcare services may consider forming a PSN. To form a PSN, providers must be sufficiently capitalized to compete with HMOs, create a formal legal organization, and develop a financial plan. To ensure that its goals are met, the PSN must develop a sales promotion plan, enroll members, control and monitor financial resources and clinical outcomes, and implement a management information system. Other crucial capabilities that a PSN must develop include establishing mechanisms for utilization review, membership information maintenance, claims adjudication, physician credentialing, quality assurance, and member grievance procedures.

Capital Financing↗
PubMedDate not supplied

The hidden risks and subtleties of capitation or, what you were never told when you agreed to accept capitated risk.

For your physician practice to be successful under a capitated contract, you must understand the subtleties of the arrangement that can impact the practice's level of risk exposure. This means you must know the key questions to ask when negotiating the contract and capitation amount, as well as what should be monitored to ensure the contract is implemented correctly. How the capitated rate is calculated and whether or not it appropriately covers the risk of each benefit plan the practice will be servicing will determine the financial viability of the contractual agreement. In addition, after the contract becomes effective, you should make sure that the practice is providing and billing for services consistent with its contractual obligations, and that the reimbursement received is correct based on the practice's membership mix.

Capitation Fee↗