CPB Certified Professional Biller Certification Practice Exam

What is capitation in a healthcare context?

1. A fixed fee paid to consultants

2. Preestablished payments for services over a specific period

3. Compensation based on the number of patients treated

4. Payments determined by the complexity of care provided

The correct answer is: Preestablished payments for services over a specific period

Capitation in a healthcare context refers to a payment model where a healthcare provider receives a preestablished amount for providing a range of services to a patient over a specified period, typically per month. This fixed payment arrangement incentivizes providers to offer these services efficiently and manage the patient's overall care effectively. By focusing on preventive care and managing resources wisely, capitation aims to improve patient outcomes while controlling costs. As a result, healthcare providers under a capitation model are motivated to maintain the health of their patients actively rather than being paid for the number of services rendered. The other payment models mentioned are distinct from capitation: a fixed fee paid to consultants is unrelated to patient care continuity; compensation based on the number of patients treated directly ties payment to volume rather than value; and payments determined by the complexity of care provided reflect a fee-for-service model focused on the specifics of each individual case.