Risk Issues Flashcards
1
Q
Risk in insurance refers to______
A
who is paying the bill
2
Q
who bears the risk in fee-for-service?
A
patient or insurance company
3
Q
How do physicians avoid going broke in capitation systems?
A
- utilize carve outs for needed services
- negotiate risk based capitation fees
- negotiate for stop loss coverage
4
Q
what are carve outs?
A
…
5
Q
How do capitated IPAs attempt to control costs?
A
- gate keeper (controlling referrals)
2. utilization reviews
6
Q
In a tiered system where both the IPA and the physicians are capitated (cap-cap) the risk is shared but is generally greater to whom?
A
the IPA
7
Q
In a tiered system where the IPA is capitated (always) but the physicians are fee-for-service, the IPA alone is at risk from where?????
A
both sides????
8
Q
T/F: if a physician is salaried he is protected from financial risk
A
True
