Fee-For-Service Definition
Fee-For-Service (FFS) is defined in the EPM as: A method of payment for health services. The medical provider bills the insurer and is paid for specific individual services.
For MHCP enrollees whose coverage is delivered through FFS:
- They obtain health care services from an MHCP provider by presenting their MHCP membership card.
- DHS pays claims directly to the provider.
- Enrollees receive an explanation of medical benefits (EOMB) each month showing the FFS claims DHS has paid on their behalf.
Definition: A statement from DHS, an insurance company, or a health plan reporting amounts paid, reduced, or denied for the client's health care expenses.Clients who can not enroll into a managed care health plan have an “exclusion” from managed care participation. You have used this terminology in delivery of basic MA services to clients of all ages.
Page 6
Managed Care vs. Fee-For-Service