The population health nurse is explaining to a patient about the type of health services that are paid for by a third party such as private health insurance. What is the nurse explaining to this patient?
1. Capitation payment.
2. Deductible payment.
3. Prospective reimbursement.
4. Retrospective reimbursement.
Answer: 3
Explanation: 3. Third party payment is made through reimbursement for services rendered. Prospective payment is most commonly utilized today, with payment given at a predetermined fixed rate for a specific set of services. Retrospective reimbursement was formerly the primary form of third party payment for services rendered based on the cost of the services. Rising health prices and spiraling insurance health care costs now limit this form of reimbursement because some services were given solely for reimbursement purposes and not for health reasons. Deductible payments are those payments the person makes out of pocket until a limit is reached where the insurance company will take over responsibility for payment. Capitation refers to a prospective payment system that pays health plans or providers a fixed amount per enrollee per month for providing a defined set of health needs.
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