What term describes a predetermined, fixed amount of reimbursement?

The term that describes a predetermined, fixed amount of reimbursement is the prospective payment system. This system is an essential component of healthcare financing, particularly in Medicare and Medicaid programs. Under this arrangement, providers receive a set payment amount for specific services or procedures before the services are rendered, regardless of the actual costs incurred during the provision of care.

This fixed payment is calculated based on various factors, such as diagnosis-related groups (DRGs) for hospital services or other classifications that reflect the expected costs of care. The aim of the prospective payment system is to encourage efficiency and cost-effectiveness among providers, as they are incentivized to deliver high-quality care while managing their resources wisely.

In contrast, fee-for-service refers to a model where providers are reimbursed for each individual service provided, leading to potentially higher costs. Capitation involves a fixed payment per patient for a specified period, which is somewhat similar but focused on total patient care rather than specific services. Incentive payments generally refer to additional funds provided to reward high-quality care or performance metrics rather than a predetermined reimbursement amount.