Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:Introduction to Health Care and Public Health in the U.S.
Unit:Financing Health Care - Part 2
Lecture:The Billing Process of Various Health Care Enterprises
Slide content:FFS: Traditional Retrospective - 1 Payment made after services have been provided Method used by commercial or indemnity insurance policies Fee schedule Developed using historical claims data Lists allowable services and procedures and amounts payable for each 11
Slide notes:A traditional retrospective fee-for-service payment refers to the payment by third-party payors, usually under a commercial or indemnity plan, after services have been provided. Payments are based upon a fee schedule developed from historical claim data using the average of the usual, customary, and reasonable charges that have been submitted by providers over time. A fee schedule is the third party payor equivalent of the providers charge description master. It is a list of allowable services and procedures, and the amounts payable for each. Some medical services may not be allowable or payable, for example cosmetic plastic surgery. 11