In a bundled payment, payment is based on average total costs for a patient based on their ___.

• A. geographic location
• B. age and gender
• C. insurance status
• D. presenting problem and co-morbid conditions

Answer: (D)

Bundled payment sets a single payment to cover all services for an episode of care, and the amount is determined by what similar patients typically cost. The most important factor is the clinical picture: the presenting problem and the level of co-morbidity that drives resource use during the episode. This case-mix approach ensures the payment reflects expected care needs for that specific clinical scenario.

Geographic location, age and gender, or insurance status don’t reliably predict how much resources an episode will require, so they aren’t the basis for calculating the bundle.