Quote:
Originally Posted by BrianL99
That wasn't the question.
The question is, does Medicare for Advantage plans pay a "lump sum per patient" (as Rainger said) or do they pay per individual visit/procedure (as OBB said)?
I doubt it can be both ways. OBB's scenario of the "bunion story" presumes Medicare is invoiced for and pays, for each individual visit and/or procedure. I don't think that's the case with Medicare Advantage Plans. I think Medicare simply pays a "lump sum" per patient, depending on the patient's overall health condition. ("Bonuses" are irrelevant to the question).
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If you want the answer to that, first consider the common sense answer, using a common hypothetical.
MA pays X dollars for patient John. Every month. No more, no less. And then John is found to have a brain tumor that is treatable with chemo, targeted radiation, months of physical and speech therapy, home health aids, and two months in rehab.
Who's gonna pay for all that? Or will John simply die because he can't afford it? Answer: Something ELSE is going to happen, besides MA simply paying out X dollars for patient John.
What is that something else? I don't know. But I'm confident it's something else.