ReimbursementQuestion 72 of 100
Under a capitation payment arrangement, a provider is paid:
a.A separate fee for each individual service rendered
b.A fixed amount per enrolled member per month regardless of the number of services used
c.Only when the patient meets the deductible
d.Based on the hospital's DRG weight
Explanation
Capitation pays the provider a set amount per member per month (PMPM) to cover contracted services for each enrolled patient, whether or not the patient seeks care. This shifts financial risk to the provider and rewards efficient, preventive care. It contrasts with fee-for-service, which pays per service delivered.
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