Which of the following best describes capitation payment models?

Prepare effectively for the CPC Compliance and Regulatory Exam with our interactive flashcards and multiple choice questions. Get insights, hints, and explanations to ensure exam success.

The description that providers receive pre-established payments regardless of patient visits accurately captures the essence of capitation payment models. In this framework, healthcare providers are paid a fixed amount per patient, typically on a per-member, per-month basis, to cover a range of services. This method incentivizes providers to focus on preventive care and efficient management of patient health rather than volume of services delivered, as they receive a consistent payment regardless of how many services are actually rendered to each patient.

This model contrasts sharply with fee-for-service systems, where providers are compensated for each specific service provided, which can lead to higher overall costs and unnecessary interventions. Capitation aims to promote more holistic and proactive care, as it encourages providers to keep patients healthy in order to manage their costs effectively.

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