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HMOs and insurers manage their costs better than risk-assuming healthcare providers and cannot make risk-adjusted capitation payments without sacrificing profitability. Risk-transferring entities will enter into such agreements only if they can maintain the levels of profits they achieve by retaining risks. [4] [6]
Exclusions, tail risk, and stop-loss criteria: Bundled payment models may choose to set up a variety of safeguards that limit the financial risk that providers bear under extreme circumstances. Various forms of these safeguards include criteria excluding certain types of cases (such as patients with serious comorbidities), criteria excluding ...
The capitation fee comes as a surprise to the student when the student may have forsaken admission deadlines at other institutions. Choosing not to pay additional fees may even lead to a form of extortion, by withholding the degree from students. Parents often pay so that there is no ill bearing that affects their wards scores or standing. [8]
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.
The IPA assembles care providers in self-directed groups within a geographic region to invent and implement health improvement solutions, form collaborative efforts among care providers to implement these programs, and exert political influence upward within the community to effect positive change. [citation needed]
BOSTON (Reuters) -McKinsey & Co has agreed to pay $650 million to resolve a U.S. Department of Justice investigation into the consulting firm's work advising opioid manufacturer OxyContin maker ...
A lawyer for sex trafficking victims in a ring allegedly run by ex-Abercrombie & Fitch CEO Mike Jeffries has doubts about claims he has dementia.
President-elect Donald Trump plans to launch a mass deportation operation targeting millions of immigrants living in the U.S. illegally and with temporary protections once he takes office on Jan ...