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In the United States, an independent practice association (IPA) is an association of independent physicians, or other organizations that contracts with independent care delivery organizations, and provides services to managed care organizations on a negotiated per capita rate, flat retainer fee, or negotiated fee-for-service basis. [1] [2]
The American Hospital Association and the American Medical Association (AMA) have spoken out against the board. [36] [37] The AMA wanted to change the IPAB requirement that members have no outside employment so working physicians could be considered. [38] The AMA also opposed any independent commission which could cut physician payment rates. [39]
An Independent Practice Association is a legal entity that contracts with a group of physicians to provide service to the HMO's members. Most often, the physicians are paid on a basis of capitation , which in this context means a set amount for each enrolled person assigned to that physician or group of physicians, whether or not that person ...
Analysis of a clinical and cost utilization data from the years 2003 to 2005 by an integrative medicine independent physician association (IPA) which looked the chiropractic services utilization found that the clinical and cost utilization of chiropractic services based on 70,274 member-months over a 7-year period decreased patient costs ...
Denied Claims. These claims are properly filed but do not meet the payor’s criteria for payment. Common reasons include billing for services not covered by the plan, highlighting the importance of verifying insurance coverage during patient registration. Denied claims require investigation to identify the issue and prevent future occurrences.
If not already part of a group medical practice, physicians may contract with an independent practice association (IPA), which in turn contracts with the HMO. This model is an example of an open-panel HMO, where a physician may maintain their own office and may see non-HMO members.
It was based on the Sac-Sierra Medical Clinic structure of a "clinic without walls". CareMore was structured as a partnership of corporations with a wrap-around IPA. The ownership included 33 mostly independent primary care physicians as a small Southern California regional medical partnership. the company was rebranded as Carelon Health in 2024.
Unlike PPOs, however, HMOs often require members to select a primary care physician (PCP), a doctor who acts as a gatekeeper to direct access to non-emergency medical services, and are required to first obtain a referral from their PCP in order to be reimbursed for the cost of medical services inside of their network of designated doctors and ...