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October 19th, 2022

Respond to one of the following Discussion topics for your initial response.

Discussion Topics:

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1.        What are the four major activities of a health plan? Choose one activity and describe.

2.        How is charity care defined?

3.        Why is the unreimbursed cost of Medicare not included as an element of community benefit?

4.        You have been asked to develop a capitation rate for a primary care group based on the following projection.

Service Annual Frequency/1000 Cost per Service
Inpatient visits 100 $7,000.00
Office visits 3000 $45.00
Lab/X-ray 500 $25.00

 

Define PMPM. What PMPM rate would be required to break even, ignoring any copayments?

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