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A payment methodology in managed care which consists of pre-established payment for services provided over a period of time is known as _ _ _ _ _ _ _ _ _ _ _ _.

a) Fee-for-Service (FFS)
b) Capitation
c) Coinsurance
d) Deductible

1 Answer

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Final answer:

The correct answer to the payment methodology in managed care where providers are paid a fixed amount per person over a period of time is known as capitation (option b). This is different from fee-for-service, deductibles, and coinsurance, each involving different methods of payment or cost-sharing between the insurance company and the policyholder.

Step-by-step explanation:

A payment methodology in managed care which consists of pre-established payment for services provided over a period of time is known as capitation. Unlike fee-for-service (FFS) where medical care providers are reimbursed according to the cost of services they provide, capitation involves a fixed amount per person enrolled in the plan, such as with a health maintenance organization (HMO), regardless of how many services are provided. The correct answer to the student's question is b) Capitation.

Other payment options like deductible involve an amount that insurance policyholders must pay out of pocket before the insurance coverage pays anything, while coinsurance requires the policyholder to pay a certain percentage of the costs. Deductibles, copayments, and coinsurance are methods intended to reduce moral hazard by making sure the insured party bears some of the costs before collecting insurance benefits.

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