CPB Certified Professional Biller Certification Practice Exam

What does a Customized Sub-Capitation Plan (CSCP) typically involve?

1. Paying for all medical services upfront

2. Fixed payments to providers based on patient enrollment

3. Fees based on the number of services delivered

4. Variables applied to capitation models based on patient population

The correct answer is: Fixed payments to providers based on patient enrollment

A Customized Sub-Capitation Plan (CSCP) typically involves fixed payments to providers based on patient enrollment. This arrangement allows for predictable budgeting for healthcare providers as they receive a set amount of money for each enrolled patient, regardless of the amount of care each patient ultimately requires. This system incentivizes providers to focus on preventive care and managing patient health efficiently, as their income is not directly tied to the volume of services delivered, but rather to maintaining the health of their enrolled patients. In the context of healthcare financial arrangements, options emphasizing prepayment for all services or service-based fees do not accurately capture the fundamental structure of a sub-capitation plan. Instead, the focus of a CSCP is on the stability of payment from patient enrollment, which shifts the financial risk associated with patient care management toward the providers, encouraging them to balance quality service with cost efficiency.