A physician receives a set amount of money to provide care to a given group of clients for a set period of time. Which of the following terms is being described?
a. Retrospective reimbursement
b. Prospective reimbursement
c. Fee-for-service
d. Capitation
ANS: D
Capitation describes the practice of paying physicians and other practitioners a set amount to provide care to a given client or group of clients for a set period of time and amount of money. This is similar to prospective reimbursement for health care organizations. Prospective reim-bursement is the method of paying an organization whereby the third-party payer establishes the amount of money that will be paid for the delivery of a particular service before offering the ser-vices to the client. Retrospective reimbursement is the method whereby fees for the delivery of health care services in an organization are set after services are delivered. Fee-for-service is the traditional method of paying the health care practitioner; the practitioner determines the costs of providing a service, delivers the service, and submits a bill for the delivered service to a third-party payer who then pays the bill.
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