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  • Podiatry > Payment for High Severity Patients

    Should a member be deemed a high-severity patient, additional points will be awarded to the participating podiatrist once during each member's six-month period and shall be reported on the monthly EmblemHealth remittance advice. If high-severity service occurs after the first month of payment, a payment adjustment will be made during the month the qualifying claim is processed.

    The additional points schedule is subject to change with notification to participating podiatrists. As of January 2009, the Market Share Payment program's schedule is:

    Highest Single Procedure RVUs

    0-11.71

    1 Contact Point

    11.72 or more

    5 Contact Points Case Maximum

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    Glossary terms found on this page:

    An itemized statement of health care services and their costs provided by a hospital, physician's office or other health care facility. Claims are submitted to the insurer or managed care plan by either the plan member or the provider for payment of the costs incurred.

    A health care benefit arrangement that is similar to a preferred provider organization in administration, structure and operation but does not cover out-of-network care. Also called an Exclusive Provider Organization.

    An organization comprised of individual physicians or physicians in group practices that contracts with the managed care organization on behalf of its member physicians to provide health care services. Also called an Independent Practice Association.

    Acronym for Medicare Advantage. An alternative to the traditional Medicare program in which private plans run by health insurance companies provide health care benefits that eligible beneficiaries would otherwise receive directly from the Medicare program.

    An individual and each of his or her eligible dependents, including Medicare beneficiaries who are enrolled or participate in a benefit program and who are entitled to receive covered services from the practitioner pursuant to such benefit program and the terms of the practitioner's agreement.

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