01369e17_Provider_Reimbursement_System___Setting_Methodology_Component
[Description] Capitated Rates reimburses providers based on a per member, per month basis. Payments are made at the same level, whether or not the member receives services during the month. Capitated rates stand in contrast to fee-for-service rates, where payments are based on the actual units of service provided. A case rate is similar to a capitated rate, except that case rates typically vary by type of case and are not paid until the individual receives certain services during the month.
Capitated Rates
F e e f o r S e r v i c e R a t e s
C o s t B a s e d R a t e s
R a t e S e t t l e m e n t P r o c e s s
P r o s p e c t i v e P a y m e n t R a t e s
M e d i c a r e R a t e s
P e r D i e m R a t e s
P a y f o r P e r f o r m a n c e
C a p i t a t e d R a t e s
Q u a l i t y I n c e n t i v e s
Provider Reimbursement System
Rate Setting Methodology/Component