and any other compensation to the physician or physician group to influence the use of referral services). Bonuses and other compensation that are not based on referral levels (such as bonuses based solely on quality of care furnished, patient satisfaction, and participation on committees) are not considered payments for purposes of this subpart. Referral Services - Any specialty, inpatient, outpatient, or laboratory services that a physician or physician group orders or arranges, but does not furnish. Risk Threshold - The maximum risk, if the risk is based on referral services, to which a physician or physician group may be exposed under a physician incentive plan without being at substantial financial risk. The risk threshold is 25 percent. Withhold - A percentage of payments or set dollar amount that an organization deducts for a physician’s service fee, capitation, or salary payment, and that may or may not be returned to the physician, depending on the specific predetermined factors.
and any other compensation to the physician or physician group to influence the use of referral services). Bonuses and other compensation that are not based on referral levels (such as bonuses based solely on quality of care furnished, patient satisfaction, and participation on committees) are not considered payments for purposes of this subpart. Referral Services - Any specialty, inpatient, outpatient, or laboratory services that a physician or physician group orders or arranges, but does not furnish. Risk Threshold - The maximum risk, if the risk is based on referral services, to which a physician or physician group may be exposed under a physician incentive plan without being at substantial financial risk. The risk threshold is 25 percent. Withhold - A percentage of payments or set dollar amount that an organization deducts for a physician’s service fee, capitation, or salary payment, and that may or may not be returned to the physician, depending on the specific predetermined factors.
AppendixQCCNPPhysicianIncentivesRules4.4.11.docx