A physician bills the insurance company for a computed tomography (CT) scan, laboratory tests, chest x-ray, and an extended visit and receives revenue for each procedure billed. This type of payment system is a _____ payment system
a. prospective
b. retrospective
c. diagnosis-related group
d. capitated
ANS: B
Correct: A retrospective payment system is a method of reimbursing health care providers (such as physicians and hospitals) in which professional services are rendered and charges are billed on the basis of each service provided; this is also known as a fee-for-service payment system.
a. A prospective payment system is a method of reimbursing health care providers in which the total amount of payment for care is predetermined on the basis of the client's diagnosis. This is the predominant method of payment in today's health care system.
c. A diagnosis-related group payment system refers to reimbursement for health care services that is based on a predetermined fixed price per case. This method of payment is also called a prospective payment method.
d. A capitated payment system is a method of reimbursing providers (usually primary care providers such as physicians and nurse practitioners) in which the insurance company pays the provider a set amount of money each month to provide a defined set of health care services for the client enrolled in the insurance company's health plan.
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