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CPHQ Exam

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Question:

Name the 7 types of reimbursement

Author: Alexis Hoyt



Answer:

Fee-for-service: Providers receive payment for each service provided Traditional Retrospective Payment: Pays providers after services have been provided Managed Care Reimbursement: Third Party payers manage cost of healthcare and episodes of care Episode of Care Reimbursement: Providers receive one lump sum for all services related to a condition/disease Capitation: Third party payer reimburses providers a fixed per capita amount for a period (PMPM or Per Member Per Month) Prospective Payment: Payment rates established in advance for a specified time period; pre-determined rates based on average levels of resource use (DRGs) Pay for Performance: Provides bonus to health care providers if they meet or exceed agreed upon quality or performance measures


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