Fee for Service - Glossary (2024)

FAQs

Fee for Service - Glossary? ›

Fee for Service (FFS) is a model of healthcare payment wherein providers and physicians are reimbursed based on the number of services they provide. This is in contrast to bundled payments, which are fixed amounts paid for a bundle of services or all the care a patient is expected to need.

Fee-for-service is a system of health insurance payment in which a doctor or other health care provider is paid a fee for each particular service rendered, essentially rewarding medical providers for volume and quantity of services provided, regardless of the outcome.

Definition: Fee-for-service (FFS) is a traditional health care model in which health care providers and hospitals are reimbursed based on the number of services and procedures they provide.

A significant proportion of total Medi-Cal expenditures is generated through the Fee-for-Service (FFS) health care delivery system. FFS providers render services and then submit claims for payment that are adjudicated, processed, and paid (or denied) by the Medi-Cal program's fiscal intermediary.

A method in which doctors and other health care providers are paid for each service performed. Examples of services include tests and office visits.

Service charges are also called service fees. They go by a number of different names depending on the industry, including booking fees (hotels), security fees (travel), maintenance fees (banking), and customer service fees.

Higher healthcare costs: FFS can lead to higher healthcare costs since providers are incentivized to perform more services. Lack of coordination: Since providers are paid for each service they provide, there is less incentive to coordinate care with other healthcare providers.

What is an example of fee for service? If your doctor charges $100 for office visits, you'll pay $100 upfront when you go in, and send the claim to your insurance company. In this case, you were charged $100 (your fee) for the care you received (the service).

Capitation: where a payment is made to a PCP for every patient for whom they provide care. Fee‐for‐service (FFS): where payment is made to a PCP for every item of service or unit of care that they provide.

In a fee-for-service model, providers are reimbursed based on the quantity of services delivered, whereas value-based care models focus on quality, efficiency, and patient outcomes. Fee-for-service emphasizes service volume, while value-based care incentivizes quality and cost-effective care.

Is PPO and FFS the same? ›

Fee-for-Service (FFS) Plans with a Preferred Provider Organization (PPO) - An FFS option that allows you to see medical providers who reduce their charges to the plan; you pay less money out-of-pocket when you use a PPO provider. When you visit a PPO you usually won't have to file claims or paperwork.

PPO plans allow you to go outside of your network, but the cost may increase. PFFS plans let you go outside of your network if the doctor or hospital accepts the payment terms and agrees to treat you, and SNPs* generally require you to stay in your network.

Fee-for-service (FFS) is a payment model in which doctors, hospitals, and medical practices charge separately for each service they perform.

What is a Service Charge? A service charge, also called a service fee, refers to a fee collected to pay for services that relate to a product or service that is being purchased. In other words, a service charge is an additional charge for the service provided with the purchase of a product or service.

The Medicare Fee-For-Service (FFS) program pays physicians, hospitals, and other health care facilities based on statutorily established payment systems, most of which are updated annually through regulations.

The disadvantage of a Fee-for-Service (FFS) health plan is that you pay a lot for freedom. First of all, before you even schedule an appointment with a physician, you are coughing up a higher premium than your buddies with HMOs, PPOs, or POS plans.

“Service charges typically appear on a customer's bill with a brief explanation of the purpose of the charge – i.e., to replace tipping, add to back-of-house wages, or offset expenses, depending on the circ*mstance – and the amount or percentage of the charge.

Service Fees means the monthly or annual fees set forth in the Service Order to be paid by Customer to Provider as consideration for Provider's provision to Customer of the Services, but does not include usage fees, taxes or regulatory fees or surcharges, which Customer must pay in addition to the Service Fees.

Fee-for-service/Indemnity Plan. Is a traditional type of healthcare policy. The insurance company pays fees for the services provided to the individuals covered by the policy.