Monthly fee a provider is paid for each covered patient

Monthly fee a provider is paid for each covered patient

• A. Capitation
• B. Rejected
• C. Fraud
• D. Clean claim

Answer: (A)

Capitation is a fixed monthly payment per enrolled patient, paid to a provider for a defined period of time, regardless of how many services the patient uses. This setup shifts financial risk to the provider and encourages efficient, preventive care because the provider must manage costs within the fixed amount. In this context, the monthly fee paid for each covered patient fits capitation exactly: a PMPM (per member per month) payment that stays the same whether a patient has many visits or none. It’s different from fee-for-service, where payment comes per service or visit, and it isn’t about whether a claim is rejected, nor about whether a claim is clean.

Capitation is a fixed monthly payment per enrolled patient, paid to a provider for a defined period of time, regardless of how many services the patient uses. This setup shifts financial risk to the provider and encourages efficient, preventive care because the provider must manage costs within the fixed amount.

In this context, the monthly fee paid for each covered patient fits capitation exactly: a PMPM (per member per month) payment that stays the same whether a patient has many visits or none. It’s different from fee-for-service, where payment comes per service or visit, and it isn’t about whether a claim is rejected, nor about whether a claim is clean.