Certified Revenue Cycle Representative (CRCR) Practice Exam

In service lines such as cardiology or orthopedics, what does the case-rate payment methodology allow providers to do?

1. Receive variable payments based on patient outcomes

2. Receive a fixed payment for specific procedures

3. Charge patients based on their insurance company guidelines

4. Request additional payments for follow-up services

The correct answer is: Receive a fixed payment for specific procedures

The case-rate payment methodology is designed to provide a fixed payment amount for specific procedures, regardless of the actual resources used or the length of stay required for treatment. This approach allows healthcare providers to manage their financial risk by establishing a predetermined payment that covers the entire procedure related to a patient's treatment in service lines such as cardiology or orthopedics. By using a fixed payment structure, providers can streamline their operations and predict revenue more accurately. This system encourages efficiency because providers are incentivized to deliver care within the established payment framework. If a provider can deliver care for less than the fixed rate, they can retain the difference, which ultimately supports cost control and operational efficiency. In contrast, other methodologies may focus on variable payments based on outcomes, charge patients according to insurance guidelines, or seek additional payments for follow-up, but these do not align with the fixed-rate nature of the case-rate payment methodology. This distinction is critical for understanding how such payment models influence the operational strategies of healthcare providers in specific service lines.