ABSTRACT
With the enactment of Part C of Title 18 (Medicare) of the Social Security Act via the 1997 Balanced Budget Act, and later as results of the Medicare Modernization Act and the enactment of Medicare Advantage, both CMS (Centers for Medicare and Medicaid Services) and HCFA (Health Care Financing Administration) before it initially permitted traditional provider and practitioner operations to join together in compliant ways to direct contract as Medicare professional (or provider) service organizations (PSOs) and more recently as accountable care organizations (ACOs) in conjunction with the Patient Protection and Affordable Care Act (PPACA) of 2010. These PSOs had to adopt certain aspects of traditional managed care organization (MCO) structures to operate in compliance with CMS requirements under Part C. This chapter describes some of the more common MCO organizational structures and functions that successful provider-or practitioner-based operations typically adopt.
