ReimbursementCâu 72 / 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
Giải thích
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.
Luyện miễn phí toàn bộ 100 câu hỏi — không cần đăng ký.
Câu hỏi liên quan cùng chủ đề
- In the Medicare Physician Fee Schedule, the payment for a service is calculated by:
- Diagnosis-Related Groups (DRGs) are used mainly to determine reimbursement for:
- Ambulatory Payment Classifications (APCs) are the basis for Medicare payment in the:
- In a fee-for-service reimbursement model, the provider is paid:
- A patient's total 'out-of-pocket maximum' represents:
- A provider bills $2,000 for a service. The payer's allowed amount is $1,200, and the provider is a participating (in-network) provider. What is the contractual adjustment (write-off)?
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