Resource: Chapter 1 of Medical Insurance: An Integrated Claims Process Approach
Write and post a 250- to 300- word response to the following questions:
Describe, the fee-for-service and capitation payment cycles. Include the relationship among provider, patient, and payer in your presentation, and their roles in the process.
Fees for services are listed on the doctor’s fee schedule and there are known to be separate fee’s with each code and sometimes these codes are not billable. So in saying this the patient may have to pay some fee’s before they leave the doctor’s office because of some sort of procedure they had done. So the way the relationship goes for the fees for service is like this. The patient makes their usual monthly payments to their health plan or it’s set up to be automatically withdrawn from their paycheck. If they make their payments on time then they can have medical services done by a physician. The patient then pays for any fee’s or co-pays for the medical services that were provided on that day and then the Medical Biller will then bill the health plan. The patient may be reimbursed for the some money they had to pay out of pocket. Capitation payment cycle is way different. Capitation means that there is a fixed prepayment that is paid to the medical provider for members of their plan for only necessary services provided to them. By using the capitation payment cycle the doctor may be taking risks for receiving fewer patients. Some doctor’s offices prefer this though because they are a small doctor’s office and only want to deal with people that have certain medical insurances so their biller and coder doesn’t have to learn everything else. The only thing with this though is that they medical insurance is going to pay the doctor’s office the same amount of money each month no matter what. This may cause problems for the patient because if they don’t go see their doctor that month...