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prepaid health plan

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11y ago
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12y ago

capitation

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Q: How does an hmo receive payment for the services its physician provide?
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What is a rendering physician?

Rendering Physician is the Physician who provided the services, also known a the "Treating Physician" - Billing provider is the provider that will receive payment for the services. Typically the billing provider is a Group Entity when it differs from the Rendering Physician


How does a HMO receive payment for the services its physicians provide?

An HMO is a prepaid group plan. Patients join the plan and pay monthly medical insurance premiums individually or through their employer. The physician renders service to the patient, and the patient usually pays a small co-payment and occasionally a deductible as required by the plan. Providers that join the plan are paid using the capitation method.Capitation is a system of payment used by managed care plans in which physicians and hospitals are paid fixed per capita amount for each patient enrolled over a stated period of time, regardless of the type and number of services provided.


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