Author Question: Which payment method offers to pay the provider a specific percentage of the provider's usual ... (Read 63 times)

frankwu · **on:** Jul 8, 2018

Which payment method offers to pay the provider a specific percentage of the provider's usual charge?

1. Discounted fee-for-service
2. Per diem rates
3. Diagnosis-related groups
4. Capitation

Question 2

Which statements, made by a nursing student, would the faculty interpret as a good understanding of the role of third-party payers in healthcare financing? Select all that apply.

1. Third-party payers have the power to influence care and reimbursement.
2. Third-party payers manage or administer the pool of money from individuals who decide to join an insurance plan.
3. Third-party payers carry all the financial risk for healthcare.
4. Third-party payers pay or underwrite coverage for healthcare for another entity.
5. Third-party payers use reimbursement strategies primarily aimed at reducing the financial risk.

alexisweber49 · **Reply #1 on:** Jul 8, 2018

Answer to Question 1

1
Explanation: 1. Discounted fee-for-service is a payment method that offers to pay the provider a specific percentage of the provider's usual charge, or a reduced rate.
2. A per diem rate is reimbursement that is fixed, based on each day in a healthcare facility.
3. DRGs are a statistical prospective payment system that classifies care or diagnoses into groups that then are used to identify payment rates.
4. Capitation is a prepayment to a provider to deliver healthcare services to enrollees of a health plan.

Answer to Question 2

1, 2, 4, 5
Explanation: 1. This is a true statement regarding the third-party payer system. This power can be misused or can be misinterpreted by the insured.
2. When individuals decide to join an insurance plan, they put a specific amount of money into the pool or the insurance fund. The third-party payer is responsible for managing and administering this money.
3. The financial risk for healthcare is carried by the patients, the providers, and the third-party payers.
4. The third-party payer is the organization that pays or underwrites coverage for healthcare for another business or entity.
5. These strategies have been developed for this very purpose.