Doctors who practice independently belong to the Independent Practitioner Association (IPA). Insurers and HMOs, including Aetna, Blue Cross, Blue Shield, CIGNA, Health Net, and PacifiCare, are just a few of the organizations it has connections with.

What are the objectives of IPA?

IPAs are created to create a distinct organizational structure for improved revenue cycle management (RCM). Additionally, it seeks to lower overhead expenses and strengthen contractual ties with employers, accountable care organizations (ACOs), and managed care organizations (MCOs). Furthermore, these organizations have more substantial negotiating positions with insurance carriers.

IPAs can collaborate with several medical specialties and institutions. A single system can deliver medical treatment from diagnostic facilities, imaging facilities, clinics, and home healthcare organizations. These tactics broaden the pool of possible patients and aid in acquiring funding and managerial resources.

Research shows that healthcare buyers seek medical assistance from ventures. They can obtain a wide range of medical treatments and deliver encouraging results with a team-based approach, which is the motivation for this. According to a recent health study, associations like IPAs offer patients with chronic diseases three times as much medical treatment as non-participating medical experts.

How does IPA operate?

The IPA has contracts with HMOs, other third-party payers, and each of its members. IPAs are subsequently given a listing in the directories of HMOs and compensated monthly for all services offered to healthcare consumers. After that, IPAs are responsible for disbursing funds to the organizations and individuals that provide the patients’ medical care.

HMO prerequisites

• The HMOs mandate that all medical professionals have proper credentials.
• IPAs must keep an eye on the standard of healthcare the company provides.
• IPAs must comply with all applicable federal and state healthcare regulations and produce audit reports regularly to prove it.

Most IPAs contract with medical billing businesses like Capline Services to manage all the required procedures and paperwork. These businesses guarantee adherence to all guidelines for effective revenue cycle management.

What are the advantages of IPA?

• Superior negotiation position with hospital systems, insurance providers, third-party payers, ACOs, radiologists, labs, and the healthcare industry.
• Improvements in EMR management, compliance, and billing information.
• Improved technology capabilities and medical care management.
• Substantial administrative backing.
• Independence in choosing what treatment is appropriate for their patients.
• Extended hours, urgent care, outreach, follow-ups, etc.
• Enhanced services such as payroll and benefits administration, group purchasing, etc.
• Lower overhead costs.

IPA disadvantages

• IPAs, particularly more recent IPAs, run the danger of underfunding and capitation loss.
• HMOs and other third-party payers may reduce payments to the IPAs.
• Conflicts may develop between monetary gain and superior medical treatment.
• The failure of associations and medical experts to manage disputes.
• Medical staff shortages can make resources and facilities unaffordable.

Considerations when joining an IPA

• The IPA’s legislative framework and profit-share distribution procedure.
• A list of the services that are available to members.
• Listing of the extra-cost services.
• Several membership categories.
• Costs and obligations associated with membership.
• Does IPA demand total integration?
• The definition, guidelines, and laws of integration.

How should I choose my IPA selection?

• The IPA’s medical treatment structure has to be effective, efficient, and have a track record of achieving the best possible health results for patients.
• The medical staff that provided the services should receive financial compensation for better treatment.
• There has to be better coordination and management between primary care doctors, specialists, and hospitals.
• The IPA’s finances and added value should be open to the public and able to secure contracts with payers and health plans.
• The freedom to select the optimal treatment for their patients should be granted to member medical professionals.
• All doctors must adhere to the same standards of fair treatment.

IPAs and Medical Groups

While sharing patient care responsibilities and physical space, medical groups are practices with numerous providers. When working in a group context, independent doctors are part of a more extensive practice, which can be advantageous because it gives them access to other doctors when dealing with complex diagnoses or other difficulties.

Each doctor in a group practice is paid according to a formula that originates from the management practice and consists of a salary plus a productivity bonus or incentive. Potential advantages for the independent physician who joins a group practice include the perception that it is less unpredictable than solitary treatment and is more likely to provide a controlled environment.

Conclusion

Implementing IPA in medical billing requires thoroughly examining prospective financing sources, stakeholder participation, proper resources, suitable provider selection, and monitoring performance metrics. By following these best methods, healthcare providers can easily use IPA and get its benefits.