What is the main difference between the fee-for-service and capitation reimbursement methods? Question 1 options:No fixed payments. Providers bill for services delivered and are paid on predetermined rates for A fixed per capita payment made periodically A fixed per capita payment made pe No fixed payments. Providers bill for Risk assumed by Healthcare providers (doctors, hosp Payers (insurance companies)
to a medical service provider (as a physician) by a managed care group (as an HMO) in return for medical care provided to enrolled individuals Risk assumed by Healthcare providers (doctors, hospitals) Payers (insurance companies) • A negotiated arrangement between payer and provider to cover specific services for a defined population over an established period of time. An example would be for an insurance company to contract with OSU Medical Center to cover all hospital care for its beneficiaries for a given year. The insurance company would pay OSU a fixed amount of money per month, knowing that hospital service utilization could fluctuate each month. • Fee-for-service ( FFS ) is a payment model where services are unbundled and paid for separately. In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care. Save Question 2(1 point) What is the primary distinction between prospective payment and retrospective payment? Question 2 options: Prospective payment has the price set in advance. Retrospective payments have the billing completed after services A Prospective Payment System (PPS) is a method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount. The payment amount for a particular service is derived based on the classification system of that service (for example, diagnosis-related groups for inpatient hospital services). Retrospective Payment Method. The retrospective payment method is considered a fee-for service payment method. This methodology involves insurance companies and other third parties making payments after the provider has rendered a service, based on what the provider charges for the service rendered.
Save Question 3 (1 point) True or False? Some benefits under Medicare part A include hospital stays, skilled nursing care, and home health care.True Question 3 options: True
False Save Question 4 (1 point) True or False? All outpatient procedures have an assigned Ambulatory Payment Classification (APC) code.false Question 4 options: True False Save Question 5 (1 point) True or False? A hospital that is caring for a Medicare patient on an inpatient basis generally can increase its reimbursement by providing additional services.false Question 5 options: True False Save
- Spring '17
- Options, Healthcare Finance