You started working for a private insurance company before the inception of managed care. You've been talking with your co-workers about how different reimbursement was in the past. You commented that before managed care, your employer reimbursed providers on a
a. prospective basis
b. retrospective, fee-for-service basis
c. cash-benefit basis
d. medically needy basis
Answers a, c, d make no sense at all.
To determine the correct answer, let's break down and understand each option:
a. Prospective basis: This refers to a system in which reimbursement is determined in advance or based on predetermined criteria. In this case, providers would be reimbursed an agreed-upon amount for the services they provide. However, this option may not align with the question since it does not specifically address a reimbursement method before the inception of managed care.
b. Retrospective, fee-for-service basis: This refers to a reimbursement system in which providers are paid based on the number and type of services they render. Under fee-for-service, providers bill for each service performed, and insurance companies reimburse them based on a predetermined fee schedule. This option seems plausible because it mentions the retrospective nature of reimbursement and the fee-for-service model.
c. Cash-benefit basis: This is a less common term in the context of reimbursement. It does not have a standard meaning in the insurance industry or specific relevance to provider reimbursement.
d. Medically needy basis: This is also an unfamiliar term in the context of reimbursement. "Medically needy" typically refers to a program that provides healthcare coverage for individuals who have high medical expenses but do not qualify for traditional Medicaid. It does not directly describe a reimbursement method.
Based on the options provided, the most appropriate answer to the question is:
b. Retrospective, fee-for-service basis