CPB (Certified Professional Biller) Certification Practice Exam

What categorizes the Ambulance Fee Schedule payment system?

1. Retrospective payment

2. Quality-based reimbursement

3. Prospective payment

4. Value-based pricing

The correct answer is: Prospective payment

The Ambulance Fee Schedule payment system is categorized as a prospective payment system. This means that payment rates are established in advance for the services provided, regardless of the actual cost incurred during the delivery of care. In a prospective payment model, healthcare providers are reimbursed a predetermined amount based on specific criteria set by the payer before the service is provided. This categorization is significant because it encourages providers to operate efficiently and optimize their resources, as the set rates do not change based on the care delivered. It contrasts with retrospective payment models, where payments are made after services are rendered based on the actual costs incurred. Quality-based reimbursement and value-based pricing focus more on the outcomes and value of care rather than the upfront established rates, further differentiating them from the nature of the Ambulance Fee Schedule.