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Secondary capitation is a relationship arranged by a managed care organization between a physician and a secondary or specialist provider, such as an X-ray facility or ancillary facility such as a durable medical equipment supplier whose secondary provider is also paid capitation based on that PCP's enrolled membership.
In a 1997 analysis, it was estimated that in 1991–1993, the original four hospitals would have had expenditures of $110.8 million for coronary artery bypasses for Medicare beneficiaries, but the change in reimbursement methodology saved $15.31 million for Medicare and $1.84 million for Medicare beneficiaries and their supplemental insurers ...
Medicaid managed care Medicaid and additional services in the United States through an arrangement between a state Medicaid agency and managed care organizations (MCOs) that accept a set payment – "capitation" – for these services. [1]
The term "Professional Caregiver Insurance Risk" [39] [40] explains the inefficiencies in health care finance that result when insurance risks are inefficiently transferred to health care providers who are expected to cover such costs in return for their capitation payments. As Cox (2006) demonstrates, providers cannot be adequately compensated ...
Medicaid reform tied to the Affordable Care Act, more commonly known as Obamacare or the ACA, is adding millions of new members worth billions in new premiums for insurers. More than 6 million ...
The primary public programs are Medicare, a federal social insurance program for seniors (generally persons aged 65 and over) and certain disabled individuals; Medicaid, funded jointly by the federal government and states but administered at the state level, which covers certain very low income children and their families; and CHIP, also a ...
It is jointly managed and financed by the federal government and the states. More than 70 million Americans are enrolled in Medicaid or the Children’s Health Insurance Program, a related benefit. Medicaid mainly covers children, pregnant women, some parents of poor kids, people with disabilities and elderly nursing home patients.
Medicaid also offers benefits not normally covered by Medicare, like nursing home care and personal care services. Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States, providing free health insurance to low-income and disabled people. [41]