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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.
Unlike capitation, bundled payment does not penalize providers for caring for sicker patients. [ 5 ] Considering the advantages and disadvantages of fee-for-service, pay for performance , bundled payment for episodes of care, and global payment such as capitation, Mechanic and Altman concluded that "episode payments are the most immediately ...
Despite a perception that IPAs have been formed to negotiate as a group with insurance companies in an attempt to improve rates of compensation, under the Federal Trade Commission Act, they cannot negotiate as a group with insurance companies for the providers' other insurance reimbursement. The IPA can only negotiate for the IPA members those ...
Capitation fees are generally seen as a main revenue generator that private institutions may charge, which contend that admissions that cater to affordable sections of society somehow affect the overall number of students educated. [9] [10] The government also controls the seat allocation, number and ratio of management, payment, and free seats ...
Legal treatises are one of the most important sources of secondary authority about California law. These texts are expressly recognized as a source of 'unwritten law' by California's Code of Civil Procedure. [15] The two most influential treatises are published by The Witkin Legal Institute Summary of California Law and The Rutter Group. [16]
HMOs in the United States are regulated at both the state and federal levels. They are licensed by the states, under a license that is known as a certificate of authority (COA) rather than under an insurance license. [9] State and federal regulators also issue mandates, requirements for health maintenance organizations to provide particular ...
Medicaid estate recovery is a required process under United States federal law in which state governments adjust (settle) or recover the cost of care and services from the estates of those who received Medicaid benefits after they die. By law, states may not settle any payments until after the beneficiary's death.
For example, as enacted in California, the Civil Code contains a definition of consideration, [4] a principle in the common law of contracts which has no direct equivalent in civil law systems. Similarly, it codifies the mailbox rule that communication of acceptance is effective when dropped in the mail, [ 5 ] [ 6 ] which is a feature unique to ...