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Capitated pricing is a model established that allows healthcare providers to purchase medical products and devices from a variety of OEMs at set levels based on the level of the product. For example there may be 3 levels: Standard, High, and Premium. Each OEM will establish their products that fall into each of these categories by a certain set of characteristics that make these products "equal" from a clinical effectiveness point of view. Then the healthcare provider will pay each OEM the same amount for any product in each level. For example: $3500 for all Standards, $5000 fro all High, and $7500 for all Premiums. The capitated pricing model also allows for OEMs to produce a special or "niche" product that does not fall into these categories if they can prove the clinical reasoning.
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What is non capitated health insurance?
A managed care plan is non-capitated when there is no dollar amount set to cover the cost of health care services delivered for a member during a specified length of time.
What are the critical differences in profit analysis when conducted in a capitated environment versus a fee-for-service environment?
Explain the critical differences in profit analysis when conducted under a capitated environment versus a fee-for service environment.
Why do charges need to be adjusted for patients who are covered under a capitated insurance plan?
Because they are not being charged on specific procedures. Under a capitated plan a flat fee is paid to the physician no matter how many times a patient receives treatment.
What would happen if a capitated patient account was not adjusted to a zero balance?
the patient would have to pay
What is capitated health insurance?
capitated health insurance is when a physician gets paid a specified dollar amount, for a given time period, to take care of the medical needs of a specified group of people. Often used in Health Maintenance Organization (HMO) Insurance Plans.
Is a capitated payment prepaid to a provider to cover a plan members health services for a specified period?
yes
What are the different pricing methods in international marketing?
Bid Pricing Cost Plus Pricing Customary Pricing Differential Pricing Diversionary Pricing Dumping Pricing Experience Curve Pricing Loss Leader Pricing Market Pricing Predatory Pricing Prestige Pricing Professional Pricing Promotional Pricing Single Price for all Special Event Pricing Target Pricing
What is another name for a policyholder?
Insurance companies often refer to policy holders as "heads" (especially in capitated systems) or "lives".
Can a PPO dentist be used in an HMO plan?
No. For one, in an HMO the providers are "capitated" paid part of the premium EVERY month, whether you use their services or not.
What is an arbitrage pricing theory?
An arbitrage pricing theory is a theory of asset pricing serving as a framework for the arbitrage pricing model.
What do you mean by pricing?
transfer pricing is in the case of transferred with in the organisation the pricing of contribution for assets ,
Explain how product form pricing may be a pricing option at Quills?
Explain how product form pricing may be pricing option at Quills?
