Podiatry > Market Share Payment Program For Podiatry Services Overview
Retired as of November 1, 2018
In order to streamline the payment system, all podiatrists participating in this program are reimbursed under the Market Share Payment (MSP) program methodology.
The MSP methodology affords numerous advantages, such as:
- Monthly payments that normalize cash flow
- Simplified billing based on global payments for new patient referrals
- Increased opportunities for improved efficiencies
Under MSP, practitioners receive a point each month for each new member referral (as identified by submitted claims) which translates to a global payment covering six months of professional services rendered. This covers the initial visit, as well as any subsequent procedures performed by the podiatrist for the same member. If, at the end of six months, the practitioner is still treating the member, the cycle starts over and the practitioner receives another point and another six-month payment for that member.
All professional services rendered are covered under MSP, including, but not limited to, diagnostic tests, surgery, in-patient care, surgical follow-ups, office care and office procedures.
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 test or procedure ordered by a physician to determine if the patient has a certain condition or disease based upon specific signs or symptoms demonstrated by the patient. Such diagnostic tools include radiology, ultrasound, nuclear medicine, laboratory and pathology services.
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.
A health plan that offers benefits in-network and out-of-network. In-network services are available to enrollees at lower out-of-pocket cost than the services of non-network providers. In addition, PPO enrollees may self-refer to any network provider at any time. Also called a Preferred Provider Organization.
A recommendation by a physician that an enrollee receive care from a specialty physician or facility.