Question

In services lines such as cardiology or orthopedics, what does the case-rate payment methodology allow providers to do?

Answer 1

The case-rate payment methodology allows providers to receive a fixed payment for a specific case or procedure, regardless of the actual cost of providing the service. This encourages providers to be more efficient in delivering care and controlling costs.

Step-by-step explanation:

The case-rate payment methodology in service lines such as cardiology or orthopedics allows providers to receive a fixed payment for a specific case or procedure, regardless of the actual cost of providing the service. This method encourages providers to be more efficient in delivering care and controlling costs. For example, if a cardiology provider receives a case-rate payment for performing a heart catheterization, they will receive the same payment regardless of the resources used or the complexity of the case. This incentivizes providers to streamline their processes and deliver quality care while avoiding unnecessary tests or procedures.