Which term is associated with the fee-for-service payment type?

Which term is associated with the fee-for-service payment type?

• A. Episode-of-care
• B. Traditional retrospective
• C. Prospective payment
• D. Global payment

Answer: (B)

Fee-for-service reimburses for each service provided, and payments have traditionally been made after the care is delivered. This retrospective nature means the payer reviews the completed claim, determines coverage, and reimburses based on charges or allowed rates for the individual services. That makes traditional retrospective the best fit for describing fee-for-service. In contrast, episode-of-care refers to payment for a defined clinical episode, often bundled and frequently established ahead of time; prospective payment sets a predetermined amount before services for a defined condition or encounter; global payment covers a set period or a population, commonly tied to capitation or broad bundles.

Fee-for-service reimburses for each service provided, and payments have traditionally been made after the care is delivered. This retrospective nature means the payer reviews the completed claim, determines coverage, and reimburses based on charges or allowed rates for the individual services. That makes traditional retrospective the best fit for describing fee-for-service.

In contrast, episode-of-care refers to payment for a defined clinical episode, often bundled and frequently established ahead of time; prospective payment sets a predetermined amount before services for a defined condition or encounter; global payment covers a set period or a population, commonly tied to capitation or broad bundles.