Hcr/ Fee-for-Service

Fee-for-service payment method is based on provider charges which also mean the fee is paid after the patient receives services from the doctor. Fee-for-service would consist of the patient paying his or her monthly payment on time and then when visiting the doctor unless there is a co pay or a procedure that is done that day then there is no payment needed. If by chance there is a procedure done that day then before leaving there might be a cost when the medical biller bills the company the health insurance company might give the money back that you had to pay out of pocket. So the relationship between provider, patient, and the payer would be that the patient comes to see the provider for health issues, and the patient might have to pay a co pay, then the medical biller bills the payer and then the provider gets paid. Capitation is a fixed payment to a medical provider for all necessary services. This payment is received before the patient is seen and is received monthly even if the holder is not medically seen that month. The relationship between these is like this: the patient pays a monthly payment of the same rate every month to the payer who then pays the provider. The provider does take a chance of having to take a loss this way because all the patients are paying a set rate every month which covers whatever needs to be done. This means that if the patient comes in to be seen one time a month the provider took his chance and benefitted from this. Another occasion could happen and the patient be seen twenty times in that same month and still only had to pay that monthly rate and the provider would then be losing on his