1. Define prospective reimbursement. How is this methodology different from

1. Define prospective reimbursement. How is this methodology different from retrospective reimbursement? 2. Calvin saw his primary care physician, Dr. Washington, because he had a fever and a sore throat. Dr. Washington ordered and performed a rapid strep test. Calvin’s test was positive, and he was diagnosed with streptococcal pharyngitis (strep throat). Dr. Washington wrote Calvin a prescription for amoxicillin to treat the pharyngitis. Dr. Washington submitted the following charges to Calvin’s insurance company, Super Payer: • Clinic visit, level 2-$145 • Rapid strep test-$50 Dr. Washington’s practice has a contract with Super Payer and the reimbursement methodology is a fee schedule. The fee schedule rate for a level 2 clinic visit is $70 and the fee schedule rate for a rapid strep test is $10. What is the total reimbursement Dr. Washington will receive for Calvin’s office visit? 3. Super Payer has a contract with Community Hospital to provide inpatient care for their beneficiaries. They have agreed to a per diem reimbursement methodology. ICU days

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