Withhold

The portion of a payment due a physician in a managed care plan which is held back by the plan in order to provide a contingency fund to be used in case 1) the usage under the plan exceeds the predictions under which the premiums were established, and the plan is unable to pay the full amount (the withheld money is needed for more claims or other unexpected costs), and 2) in case the plan has a system for releasing the withhold variably to different physicians under a formula which takes into account the relative productivity and performance of each physician. The withheld amount is typically about 20% of the claims, and is sometimes called the “physician contingency reserve” (PCR).


 


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