Adult-Gerontology Clinical Nurse Specialist (CNS) Practice Exam

What type of payment approach does Medicare use primarily?

1. Retrospective payment scale

2. Prospective payment scale

3. Resource-based relative value scale

4. Capitation

The correct answer is: Resource-based relative value scale

The correct answer focuses on the Resource-Based Relative Value Scale (RBRVS) as the primary payment approach used by Medicare. This system assigns a value to a medical service based on the resources required to provide it, including the time, skill, and overhead costs associated with the service. Each service is then converted into a dollar amount, which is used to determine the payment to healthcare providers. RBRVS is designed to promote fairness in compensation across different specialties and types of medical services, enabling a more equitable distribution of payment. It allows Medicare to control costs while ensuring that healthcare professionals are reimbursed fairly for the resources they utilize. Other payment approaches are less relevant to the context of how Medicare primarily operates. For instance, a retrospective payment scale reimburses providers after services have been rendered based on actual costs incurred, which can lead to variable spending and lack of cost control. Prospective payment systems generally involve fixed payments determined before services are provided, but they're more associated with hospitals under Medicare's Inpatient Prospective Payment System (IPPS) rather than with the overall payment approach. Capitation is a model where providers receive a set amount per patient regardless of services rendered, which diverges sharply from the detailed resource-based scheme of the RBRVS.