What is the method of payment called where a provider receives a set dollar amount for each patient for a specific time period?

What is the method of payment called where a provider receives a set dollar amount for each patient for a specific time period?

• A. Capitation
• B. Case Management
• C. Chargemaster
• D. Comprehensive Error Rate Testing

Answer: (A)

The method of payment where a provider receives a predetermined, set dollar amount for each patient over a specific time period is known as capitation. This payment model is commonly used in healthcare systems, particularly in managed care, to incentivize providers to focus on preventive care and manage the overall health of their patients effectively. Under capitation, providers are paid a fixed amount regardless of the number of services a patient uses, which encourages them to offer necessary medical services without overutilization. In contrast, case management refers to a process that coordinates patient care, often involving multiple providers and services, but does not dictate the payment structure. The chargemaster is a comprehensive listing of items billable to a hospital patient or insurance provider, serving as a pricing tool rather than a payment method. Comprehensive Error Rate Testing is a quality assurance tool primarily used to assess the accuracy of Medicare claims but is unrelated to provider payment methodologies.

The method of payment where a provider receives a predetermined, set dollar amount for each patient over a specific time period is known as capitation. This payment model is commonly used in healthcare systems, particularly in managed care, to incentivize providers to focus on preventive care and manage the overall health of their patients effectively. Under capitation, providers are paid a fixed amount regardless of the number of services a patient uses, which encourages them to offer necessary medical services without overutilization.

In contrast, case management refers to a process that coordinates patient care, often involving multiple providers and services, but does not dictate the payment structure. The chargemaster is a comprehensive listing of items billable to a hospital patient or insurance provider, serving as a pricing tool rather than a payment method. Comprehensive Error Rate Testing is a quality assurance tool primarily used to assess the accuracy of Medicare claims but is unrelated to provider payment methodologies.