PGP Member definition

PGP Member or “Member of the PGP” means a physician or NPP who is an owner or employee of a PGP or has entered into a contract with a PGP, and who has reassigned to the PGP his or her right to receive Medicare payment.

PGP Member or “Member of the PGP” means a physician or non-physician practitioner who is an owner or employee of a PGP or has entered into a contract with a PGP, and who has reassigned to the PGP his or her right to receive Medicare payment.

PGP Member or “Member of the PGP” means a physician or NPP who is an owner or employee of a PGP or has entered into a contract with a PGP, and who has

Examples of PGP Member in a sentence

• If any proposed Care Partner is a PGP, the proposed Care Partner List must identify each proposed Downstream Care Partner by the PGP name, billing TIN of the PGP, and the name and NPI of each proposed Downstream Care Partner who is a PGP Member of that PGP.

• The Hospital shall not enter into a Care Partner Arrangement with any individual who is a PGP Member of a PGP Care Partner.

• For the purposes of this condition, “referral” includes referrals by the Care Partner or other business generated by, between, and among the Hospital, Care Partner, and any individual or entity affiliated with the Hospital or Care Partner (including a PGP Member in the case of a PGP Care Partner).

• These terms include, but are not limited to, the following: Allowable CRP Interventions, Approved Track Implementation Protocol, Care Partner, Care Partner Arrangement, CRP Intervention, CRP Track, Downstream Care Partner, Downstream Care Partner Arrangement, Downstream Incentive Payment, Hospital, Incentive Payment, Incentive Payment Methodology, Incentive Payment Pool, Intervention Resource, Intervention Resource Allocation, Medicare FFS Beneficiary, Performance Period, PGP Care Partner, and PGP Member.

• For the purposes of this condition, “referral” includes referrals by the Care Partner or other business generated by,between, and among the Hospital, Care Partner, and any individual or entity affiliated with the Hospital or Care Partner (including a PGP Member in the case of a PGP Care Partner).

• The Partner Distribution Payment must be derived solely from a PBP Shared Payment received by the PGP Care Partner under OCM, and such PBP Shared Payment must comply with the Care Partner Waiver or otherwise comply with the Federal anti-kickback statute and the physician self-referral law.As explained above, Partner Distribution Payments from a PGP Care Partner to a PGP Member are subject to all conditions in the waiver, which include full compliance with referenced portions of the Participation Agreement.

• Neither the Hospital nor a Care Partner may condition the opportunity to provide or receive Incentive Payments on the volume or value of referrals or business otherwise generated by, between, or among the Hospital, a Care Partner, a Downstream Care Partner, or any individual or entity affiliated with the Hospital, Care Partner (including a PGP Member), or Downstream Care Partner.

• Neither the Hospital nor the Care Partner may condition the opportunity to provide or receive Intervention Resources on the volume or value of referrals or business otherwise generated by, between, or among the Hospital, the Care Partner, or any individual or entity affiliated with the Hospital or Care Partner (including a PGP Member in the case of a Care Partner that is a PGP).