Ethics and Issues in Contemporary Nursing Related

Review Ethics and Issues in Contemporary Nursing related questions and content

A physician bills the insurance company for a computed tomography (CT) scan, laboratory tests, chest x-ray, and an extended visit and receives revenue for each procedure billed. This type of payment system is a payment system.

  • A. prospective
  • B. retrospective
  • C. diagnosis-related group
  • D. capitated
Correct Answer: D

Rationale: The correct answer is D: capitated. In a capitated payment system, the physician receives a fixed amount per patient regardless of the services provided. This incentivizes cost-effective care and promotes preventive measures. In this scenario, the physician is receiving revenue for each procedure billed, which is not characteristic of capitated payment.

A: Prospective payment is when a fixed amount is determined in advance for specific services rendered. This is not the case in the scenario provided.
B: Retrospective payment involves reimbursement after the services are provided, which is not reflected in the scenario given.
C: Diagnosis-related group (DRG) is a payment system used in hospitals based on the diagnosis and procedures performed, not applicable to individual physician billing as presented in the question.