Health Maintenance Organization
Managed Care Organizations › Health Maintenance Organization
About this specialty
(1) A form of health insurance in which its members prepay a premium for the HMO's health services which generally include inpatient and ambulatory care. For the patient, an HMO means reduced out-of-pocket costs (i.e. no deductible), no paperwork (i.e. insurance forms), and only a small copayment for each office visit to cover the paperwork handled by the HMO; (2) A organization of health care personnel and facilities that provides a comprehensive range of health services to an enrolled population for a fixed sum of money paid in advance for a specified period of time. These health services include a wide variety of medical treatments and consults, inpatient and outpatient hospitalization, home health service, ambulance service, and sometimes dental and pharmacy services. The HMO may be organized as a group model, an individual practice association (IPA), a network model or a staff model.
Source: (1) Medical Interface: Managed Care A thru Z- Managed Care Terms published by Medicom International, Bronxville, New York Telephone (914) 337-5023, p. 20; (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
Highest Medicare-paid providers
| Provider | Location | Medicare paid |
|---|---|---|
| ALLIANCE CLINIC, LLC | MINNEAPOLIS, MN | $357,251 |
| AT HOME SLEEP STUDIES LLC | LAS VEGAS, NV | $75,853 |
| JEREMY MARTINEZ, MD | ELK GROVE, CA | $65,983 |
| SUZANNE EAVES, PSY.D. | SANTA ROSA, CA | $53,704 |
| LORI HOBBS, MD | LOS ANGELES, CA | $16,476 |
| KYAW TUN, M.D. | BAKERSFIELD, CA | $1,992 |
| REX TRUONG, M.D. | BAKERSFIELD, CA | $915 |
| JOHN PASCHAL, MD | SAN DIMAS, CA | $658 |
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.