Which payment method may be used to settle a health care provider claim?

Which payment method may be used to settle a health care provider claim?

• A. Capitation
• B. Salary
• C. Per diem
• D. Fee-for-service

Answer: (D)

When a health care claim is settled, the most common approach is fee-for-service. In this method, the payer reimburses the provider for each individual service or procedure performed, usually according to a negotiated rate or a fee schedule. This aligns directly with how claims are processed: a specific service is billed on a claim, and payment is made for that service. Other methods work differently. Capitation pays a fixed amount per enrolled member per period, regardless of how many services are used, which is a prepaid arrangement and not tied to a single claim. Salary means the provider receives a set wage from an employer, independent of the number of services billed. Per diem pays a daily rate for inpatient care, which is based on days of care rather than on individual services rendered. While these methods exist in various payment arrangements, fee-for-service is the approach most associated with settling a health care provider claim on a service-by-service basis.

When a health care claim is settled, the most common approach is fee-for-service. In this method, the payer reimburses the provider for each individual service or procedure performed, usually according to a negotiated rate or a fee schedule. This aligns directly with how claims are processed: a specific service is billed on a claim, and payment is made for that service.

Other methods work differently. Capitation pays a fixed amount per enrolled member per period, regardless of how many services are used, which is a prepaid arrangement and not tied to a single claim. Salary means the provider receives a set wage from an employer, independent of the number of services billed. Per diem pays a daily rate for inpatient care, which is based on days of care rather than on individual services rendered. While these methods exist in various payment arrangements, fee-for-service is the approach most associated with settling a health care provider claim on a service-by-service basis.