What type of reimbursement method issues lump sum payments for all health care services related to a specific illness?

Prepare for the RHIA Reimbursement Test with multiple choice questions, each accompanied by hints and explanations. Ace your exam with confidence!

The reimbursement method that issues lump sum payments for all healthcare services related to a specific illness is the episode-of-care (EOC) approach. This method consolidates payments to cover a defined set of services over a specified timeframe surrounding a particular episode of care, such as a surgical procedure or treatment for a specific condition. The EOC payment includes all necessary services provided to a patient, thereby promoting efficiency and cost-effectiveness by encouraging providers to deliver the necessary care without unnecessary services or procedures.

This method contrasts with fee-for-service reimbursement, where providers are paid separately for each service rendered. Similarly, capitation involves a fixed payment per patient regardless of the services used, which does not conform to the lump-sum nature specific to episodes of care. Bundled payments also refer to a single payment for a group of related services but typically apply to a defined set of services for a broader condition rather than a specific episode encompassing the entirety of care for an individual illness. Thus, the EOC method specifically aligns with the idea of providing a lump sum payment tied to the comprehensive care related to a particular episode of illness.

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