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Secondary capitation is a relation arranged by care organization between a physician and a secondary or specialist provider, i.e. or ancillary facility or an X-ray facility. Global capitation is a relationship based on a provider who provides services and is reimbursed per-member per-month for the entire network population.
By 2001, "case rates for episodes of illness" (bundled payments) were recognized as one type of "blended payment method" (combining retrospective and prospective payment) along with "capitation with fee-for-service carve-outs" and "specialty budgets with fee-for-service or 'contact' capitation."
Fee-for-service (FFS) is a payment model where services are unbundled and paid for separately. [ 1 ] In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care.
Capitation is a payment arrangement for health care service providers. It pays a set amount for each enrolled person assigned to them, per period of time, whether or not that person seeks care. It pays a set amount for each enrolled person assigned to them, per period of time, whether or not that person seeks care.
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ACO's incentive payments are determined by comparing the organization's annual costs relative to CMS-established benchmarks. These benchmarks are based on an estimation of the total fee-for-service expenditures associated with management of a beneficiary based on fee-for-service payment in the absence of an ACO.