Prospective Payment Systems

This book examines the various types of prospective payment systems (PPS) used by healthcare providers and third-party payers. 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. 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, Medicare Ambulatory Payment Classifications, Medicare HHPPS, Medicare Skilled Nursing Resource Utilization Groups, and private third-party payers.

Duane C. Abbey

Preface, About the Author, 1. Introduction to Prospective Payment Systems, 2. Healthcare Provider Concepts, 3. Anatomy of a Prospective Payment System, 4. Medicare Severity Diagnosis Related Groups (MS-DRGs), 5. Ambulatory Payment Classifications (APCs), 6. Other Prospective Payment Systems, Conclusion and Endnote, Appendix A: Case Studies, Appendix B: Acronyms