Prospective Payment Systems

Prospective Payment Systems

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The third book in the Healthcare Payment Systems series, Prospective Payment Systems examines the various types of prospective payment systems (PPS) used by healthcare providers and third-party payers. Emphasizing the basic elements of PPS, it considers the many variations of payment for hospital inpatient and outpatient services, skilled nursing facilities, home health agencies, long-term hospital care, and rehabilitation facilities along with other providers. The book describes the anatomy of PPS, including cost reports, adjudication features and processes, relative weights, and payment processes. It outlines the features and documentation requirements for Medicare Severity Diagnosis Related Groups (MS-DRGs), the Medicare Ambulatory Payment Classifications (APCs), Medicare HHPPS, Medicare Skilled Nursing Resource Utilization Groups (RUGs), and private third-party payers. Provides a framework for understanding and analyzing the characteristics of any PPS Discusses Medicare prospective payment systems and approaches Includes specific references to helpful resources, both online and in print Facilitates a clear understanding of the complexities related to PPSa€”covering specific topics at a high level and revisiting similar topics to reinforce understanding Complete with a detailed listing of the acronyms most-commonly used in healthcare coding, billing, and reimbursement, the book includes a series of case studies that illustrate key concepts. It concludes with a discussion of the challenges with PPSa€”including compliance and overpayment issuesa€”to provide you with the real-world understanding needed to make sense of any PPS.1500 Health Insurance Claim Form Reference Instruction Manuala€”See the National Uniform Claims Committee at ... In this text, specific references may be to chapter and page Enrollment Formsa€”Go to to https://www. numbers along with the ... Medicare Claims Processing Manual (MCPM ), Publication 100-04 a—¾ The Medicare Benefit Policy Manual (MBPM), Publication 100-02 For instance, Chapter 3 of the MCPM is devoted to Inpatient Hospital Billing.

Title:Prospective Payment Systems
Author:Duane C. Abbey
Publisher:CRC Press - 2012-02-15


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