AHIP Health Plan Finance and Risk Management AHM-520 Question # 66 Topic 1 Discussion

AHIP Health Plan Finance and Risk Management AHM-520 Question # 66 Topic 1 Discussion

AHM-520 Exam Topic 1 Question 66 Discussion:
Question #: 66
Topic #: 1

The Marble Health Plan sets aside a PMPM amount for each specialty.

When a PCP in Marble's provider network refers a Marble plan member to a specialist and the specialist provides medical services to the member, the specialist begins to receive a share of those funds on a monthly basis. Marble determines the monthly payment for each specialist by dividing the number of active patients for that specialty by the total specialty pool for that month.

This form of payment, which is similar to a case rate, is known as


A.

Referral circle capitation


B.

Risk pod capitation


C.

Contact capitation


D.

Retrospective reimbursement capitation


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