Exclusive Provider Organization
Managed Care Organizations › Exclusive Provider Organization
About this specialty
(1) An EPO is a form of PPO, in which patients must visit a caregiver that is specified on its panel of providers (is a participating provider). If a visit to an outside(not participating) provider is made the EPO offers very limited or no coverage for the medical service; (2) While similar to a PPO in that an EPO allows patients to go outside the network for care, if they do so in an EPO, they are required to pay the entire cost of care. An EPO differs from an HMO in that EPO physicians do not receive capitation but instead are reimbursed only for actual services provided; (3) An organization identical to a preferred provider organization except that persons enrolled in the plan are eligible to receive benefits only when they use the services of the contracting providers. No benefits are available when non-contracting providers are used, except in certain emergency situations.
Source: (1) Medical Interface: Managed Care A thru Z- Managed Care Terms published by Medicom International, Bronxville, New York Telephone (914) 337-5023, p. 15; (2) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 58; (3) Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988.
Highest Medicare-paid providers
| Provider | Location | Medicare paid |
|---|---|---|
| STRATFORD HOSPITAL DISTRICT | STRATFORD, TX | $51,128 |
Ranked by total Medicare payments — a measure of billing volume, not care quality.
Taxonomy definitions from the NUCC Health Care Provider Taxonomy (public domain). Provider counts derived from NPPES; payment figures from CMS Medicare data. Not affiliated with CMS, NPPES, NUCC, or any government agency.