Câu 40: AHM-520: Health Plan Finance and Risk Management

The following statements illustrate common forms of capitation:1. The Antler Health Plan pays the Epsilon Group, an integrated delivery system (IDS), a capitated amount to provide substantially all of the inpatient and outpatient services that Antler offers. Under this arrangement, Epsilon accepts much of the risk that utilization rates will be higher than expected. Antler retains responsibility for the plan's marketing, enrollment, premium billing, actuarial, underwriting, and member services functions.2. The Bengal Health Plan pays an independent physician association (IPA) a capitated amount to provide both primary and specialty care to Bengal's plan members. The payments cover all physician services and associated diagnostic tests and laboratory work. The physicians in the IPA determine as a group how the individual physicians will be paid for their services. From the following answer choices, select the response that best indicates the form of capitation used by Antler and Bengal.

1. A. Antler = subcapitation -Bengal = full-risk capitation
2. B. Antler = subcapitation -Bengal = full professional capitation
3. C. Antler = global capitation -Bengal = subcapitation
4. D. Antler = global capitation -Bengal = full professional capitation — đáp án hiện tại