Reimbursement Methodologies »
Healthcare Reimbursement Exam
Questions and Answers Graded A+
Two types of Healthcare reimbursement methodologies - Correct answer-1. Fee-
For-Service
2. Episode-of-Care
fee-for-service reimbursement system - Correct answer-reimbursement is based on
what services are provided to the patient.
Self-pay
Retrospective payment
Managed care
Episode-of-care reimbursement system - Correct answer-payment is based upon
services provided for conditions for which the patient is treated.
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,There are different situations this reimbursement method applies. Depending upon
the specific method, the unit of time a patient is treated may affect the received
reimbursement.
reimbursement is based on the patient's particular condition/illness or a specified
time period over which the patient receives care.
Managed care - capitation
Global payment
Prospective payment
Self-Pay - Correct answer-Patients without third-party payer coverage or with very
restrictive third-party coverage pay for healthcare services on a fee-for-service
basis.
Payment options for self-pay patients vary depending on the policies of the
healthcare provider. Some providers will not see patients who do not have
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, insurance coverage without payment in full at the time of service. Other providers
offer options for monthly payment plans.
Retrospective Payment - Correct answer-Retrospective payment is described as a
fee-for-service that is reimbursed to providers after health services have been
given.
payment is based on costs or charges actually incurred for the care of the patient
during his or her healthcare encounter. Payment decisions are made after the costs
are incurred (retrospectively).
discounted fee-for-service retrospective payment system - Correct answer-the
third-party payer pays less than the full price charged for the service. Depending on
the contractual agreement(s) between provider, third-party payer, and patient, the
difference between the price charged and the amount paid by the third-party payer
may or may not be passed on to the patient. In other words, the discount gained by
the third-party payer doesn't necessarily have to be passed on to the patient.
Fee Schedules - Correct answer-
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Healthcare Reimbursement Exam
Questions and Answers Graded A+
Two types of Healthcare reimbursement methodologies - Correct answer-1. Fee-
For-Service
2. Episode-of-Care
fee-for-service reimbursement system - Correct answer-reimbursement is based on
what services are provided to the patient.
Self-pay
Retrospective payment
Managed care
Episode-of-care reimbursement system - Correct answer-payment is based upon
services provided for conditions for which the patient is treated.
©COPYRIGHT 2025, ALL RIGHTS RESERVED 1
,There are different situations this reimbursement method applies. Depending upon
the specific method, the unit of time a patient is treated may affect the received
reimbursement.
reimbursement is based on the patient's particular condition/illness or a specified
time period over which the patient receives care.
Managed care - capitation
Global payment
Prospective payment
Self-Pay - Correct answer-Patients without third-party payer coverage or with very
restrictive third-party coverage pay for healthcare services on a fee-for-service
basis.
Payment options for self-pay patients vary depending on the policies of the
healthcare provider. Some providers will not see patients who do not have
©COPYRIGHT 2025, ALL RIGHTS RESERVED 2
, insurance coverage without payment in full at the time of service. Other providers
offer options for monthly payment plans.
Retrospective Payment - Correct answer-Retrospective payment is described as a
fee-for-service that is reimbursed to providers after health services have been
given.
payment is based on costs or charges actually incurred for the care of the patient
during his or her healthcare encounter. Payment decisions are made after the costs
are incurred (retrospectively).
discounted fee-for-service retrospective payment system - Correct answer-the
third-party payer pays less than the full price charged for the service. Depending on
the contractual agreement(s) between provider, third-party payer, and patient, the
difference between the price charged and the amount paid by the third-party payer
may or may not be passed on to the patient. In other words, the discount gained by
the third-party payer doesn't necessarily have to be passed on to the patient.
Fee Schedules - Correct answer-
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