Which option is not included as an episode-of-care reimbursement type?

Which option is not included as an episode-of-care reimbursement type?

• A. Self-pay
• B. Prospective payment
• C. Capitation
• D. Global payment

Answer: (A)

Self-pay is not included because episode-of-care reimbursement is a payer-driven arrangement that covers all services for a defined episode through a bundled or risk-based payment. Prospective payment sets a pre-determined amount for the entire episode, capitation provides a fixed per-patient-per-period payment for a defined set of services, and global payment is a single lump sum for all care for a defined population or period. Self-pay, on the other hand, is payment directly from the patient (out-of-pocket) and does not involve a payer arranging a bundled or risk-based payment for an episode.

Self-pay is not included because episode-of-care reimbursement is a payer-driven arrangement that covers all services for a defined episode through a bundled or risk-based payment. Prospective payment sets a pre-determined amount for the entire episode, capitation provides a fixed per-patient-per-period payment for a defined set of services, and global payment is a single lump sum for all care for a defined population or period. Self-pay, on the other hand, is payment directly from the patient (out-of-pocket) and does not involve a payer arranging a bundled or risk-based payment for an episode.