Bcbs Capitation Agreement

The main administration of the head is a relationship between a maniacted organization and a family doctor, in which the doctor is paid directly by the organization for those who have chosen the doctor as their provider. [1] Secondary Head Management is a relationship organized by a managed care organization between a physician and a secondary or specialized provider, such as an X-ray facility or a secondary organization, such as a long-life medical equipment provider, whose secondary provider is also paid on the basis of the membership of the PCP. Global capitation is a provider-based relationship that provides services and is reimbursed per member and month for the entire network population. A contract with Kopf is a health plan that allows the payment of a flat fee for each patient it covers. Under a rental agreement, an HMO or a managed care organization pays a fixed amount of money to its members to the health care provider. Capitated contracts are also called head, helmet and managed care contracts. Physicians and other health care providers do not have the actuarial, technical, accounting and financial skills to manage insurance risk, but their most serious problem is the greater variation in their estimates of average patient costs, which puts them at a financial disadvantage compared to insurers whose estimates are much more accurate. [4] [6] Because their risks depend on the size of the portfolio, providers can only reduce their risk by increasing the number of patients they carry in their working tables, but their inefficiency relative to that of insurers is much greater than can be mitigated by these increases. To manage risk as effectively as an insurer, a supplier would have to take over 100% of the insurer`s portfolio. HMOs and insurers better manage their costs as risk-taking health care providers who cannot pay risk-adjusted premiums without affecting profitability. Companies that are at risk will only enter into such agreements if they are able to maintain the level of profits they make by maintaining risks. [4] [6] An agreement between a service provider and a health care payer (Medicare or BCN) whereby the claimant also accepts the payer`s payment agreement upon acceptance of a member for treatment.

The guarantee is a fixed amount per patient per unit of time paid in advance to the physician for the provision of health care. The actual amount of money paid is determined by the offers, the number of patients involved and the period during which the services are provided. Head administration rates are developed using local costs and average service usage and can therefore vary from region to region of the country. Many plans define a pool of risks as a percentage of the premium payment. Money from this pool of risks is denied to the doctor until the end of the exercise. If the health plan works well financially, the money goes to the doctor; If the health plan is bad, the money is maintained to pay the cost of the deficit. Health care contracts have been created to improve incentives for efficiency, cost control and preventive health care. Since most people involved in a health plan will not use the services within a month, agreements on the use of head administrations should, of course, compensate high-frequency users with plan members who receive little or no health care each month. Since the physician, hospital or health care system is responsible, regardless of the health costs of the registered member, the guarantee theoretically motivates the health care provider to focus on health screenings (mammograms, pap smears, PSA tests), vaccinations, prenatal care and other preventive care that can help keep members healthy , with less reliance on expensive specialists.