Re: Risk managment payment

[Danni R.]

Thank you Dani, i also understood that much from the post. I would ask my provider to spoon feed me on this ,then i will get to you and will share with you what ever he tells me....

Yes Peter, that would be great!!!!

[Steve Verno]

Danni goes to the head of the class.  Woooooohooooo!!!!!  Yeaaaaaaaaa!!!!  You go girl!!!!!!!!!!!!!!


I searched MVP as that was the name of the insurance in the post.

Peter, it may be possible your provider is part of an IPA that is contracted with MVP.  It helps to know the terms of the contract as to how your provider is paid as part of the IPA. 

[Danni R.]

I studied the referenced PDF file. I agree, it is very hard to read and follow, but I got the over all idea.

At first I had no idea what MVP is (I thought it is an acronym for Most Valuable Player). Turns out it stands for MVP Health Plan, Inc. (MVP), a not-for-profit health maintenance organization licensed.

IPA is an organization of physicians who are contracted with an HMO plan (Independent Providers Association). In other words it's a corporation formed by physicians who maintain their independent practices, but participate in the IPA to secure managed care business.

Now if I add what Steve said into the mix:  "MVP has risk sharing arrangements with the IPAs to address the cost variance for certain medical costs. These risk-sharing arrangements differ between the IPAs. The premise is that MVP and its IPAs are responsible for certain medical costs that affect each other."

I get the over all idea. However, it is too complicated for me to even try to put it in a nutshell.

[Danni R.]

Oh, wow! That's interesting. I had no idea.
   Thanks Steve.

Yes, that was a good question, Peter.

[Steve Verno]

this is an excellent question that should be asked on a forum

the following is from the new york insurance commissioner:

Every month, MVP calculates the capitation amounts due to the three IPAs underrisk contracts with MVP (based on a per member per month method), then makes a journal entry to debit claim expenses and credit its accounts payable “due to the IPAs”. MVP invests the amounts due to the IPAs with its own funds in accordance with aninvestment pooling arrangement. Pursuant to the administrative duties specified in the IPA agreements, MVP processes and pays provider claims. MVP issues checks to IPA physicians, who are paid on a fee-for-service basis. MVP then transfers funds to IPA‘s bank accounts on a daily basis to cover the cost of all provider checks that are presented. Following the agreements between the IPAs and their participating physicians, MVP withholds varying percentages (15% or 20%) from the provider payments when issuing checks. The amounts withheld are credited to an IPA withhold liability.

Amounts to be returned to the physicians are reviewed on an annual basis. Any amounts not returned are recorded as reductions of medical expenses, with corresponding reductions made to the related liability in the physicians’ risk withholding account.

In addition, MVP has risk sharing arrangements with the IPAs to address the cost variance for certain medical costs. These risk-sharing arrangements differ between the IPAs. The premise is that MVP and its IPAs are responsible for certain medical costs that affect each other. Under the agreements, the actual medical costs of certain services are compared to budget amounts with the differences being shared by MVP and the IPA.

www.ins.state.ny.us/exam_rpt/mvpmc901.pdf

[Danni R.]

Hi Peter,

I am researching this...
Here is a link with some helpful terminology http://www.providerrisk.com/

Thanks Michelle for providing Peter with the above reference link. I, for one, was completely stumped (again!), and did not know where to begin looking for answers.