The method that the Autumn Health Plan uses for reimbursing dermatologists in its provider network involves paying them

Business, Finance, Economics, Accounting, Operations Management, Computer Science, Electrical Engineering, Mechanical Engineering, Civil Engineering, Chemical Engineering, Algebra, Precalculus, Statistics and Probabilty, Advanced Math, Physics, Chemistry, Biology, Nursing, Psychology, Certifications, Tests, Prep, and more.
Post Reply
answerhappygod
Site Admin
Posts: 899556
Joined: Mon Aug 02, 2021 8:13 am

The method that the Autumn Health Plan uses for reimbursing dermatologists in its provider network involves paying them

Post by answerhappygod »

The method that the Autumn Health Plan uses for reimbursing dermatologists in its provider network involves paying them out of a fixed pool of funds that is actuarially determined for this specialty. The amount of funds that Autumn allocates to dermatologists is based on utilization and costs of services for that discipline.
Under this reimbursement method, a dermatologist who is under contract to Autumn accumulates one point for each new referral made to the specialist by Autumn's PCPs. If the referral is classified as complicated, then the dermatologist receives 1.5 points. The value of Autumn's dermatology services fund for the first quarter was $15,000. During the quarter, Autumn's PCPs made 90 referrals, and 20 of these referrals were classified as complicated.
Autumn's method of reimbursing specialty providers can best be described as a:

A. Disease-specific arrangement
B. Contact capitation arrangement
C. Risk adjustment arrangement
D. Withhold arrangement
Join a community of subject matter experts. Register for FREE to view solutions, replies, and use search function. Request answer by replying!

This question has been solved and has 1 reply.

You must be registered to view answers and replies in this topic. Registration is free.


Register Login
 
Post Reply