Which of the following is NOT an episode-of-care reimbursement type?

• A. Self-pay
• B. Prospective payment
• C. Capitation
• D. Global payment

Answer: (A)

Episode-of-care reimbursement centers on paying for a defined span of care tied to a treatment episode, often through a bundled or predefined payment that covers multiple services. The models that fit this idea include payments made in advance based on anticipated resource use for a particular condition or episode (prospective payment), a fixed per-member-per-month amount to cover a defined set of services (capitation), and a single bundled payment for all care delivered to a patient or population over a specified period (global payment). Self-pay, on the other hand, involves the patient paying out-of-pocket for services and does not involve a payer-defined reimbursement tied to an episode of care. It’s not a bundled or prearranged payment model, which is why it is not considered an episode-of-care reimbursement type.