Explain the Prospective Payment System used by CMS to pay hospitals for inpatient care of Medicare patients. Include the reasons why it was set up and its evolution over time.
Explain the Prospective Payment System used by CMS to pay hospitals for inpatient care of Medicare...
Why does the Centers for Medicare & Medicaid Services (CMS) believe that prevention of inpatient admissions will improve the quality of care in populations served by hospitals? What specific age group and diagnoses does the CMS monitor for readmissions? Does research tell us that so far prevention of readmissions has improved the quality of care for patients? How has hospital reimbursement been affected by the readmission standard mandated by the CMS? What recommendations (best practices) to decrease hospital readmissions have...
The Medicare prospective payment system (PPS) was introduced by the federal government in October, 1983 as a way to change hospital behavior through financial incentives that encourage more cost-efficient management of medical care. Questions: Discuss two major reasons that Medicare administrators turned to the prospective payment concept for Medicare beneficiaries. Discuss the benefits and disadvantages of the Prospective Payment System.
The hospital inpatient prospective payment system (IPPS) was introduced as method of payment for inpatient hospital services to Medicare recipients to control costs. Discuss whether you believe that the implementation of IPPS has had a positive or negative impact on controlling costs.
In 1983, the United States Congress ended the retrospective, cost-based payment method that Medicare used to pay for inpatient hospital services. From 1984, most hospitals are paid under the prospective payment system (PPS). Under PPS, Medicare pays hospitals a fixed amount for each patient based on the patient’s diagnosis- related group (DRG) at the time of admission – this amount will not be affected by the hospital’s actual expenditures on the patient. a) In your own words, briefly discuss: why...
4. Define and explain Medicare and Medicaid. a. Explain how Medicare reimburses for inpatient and outpatient services. 5. Regulatory Environment of Healthcare a. Define the Stark Law and its purpose b. Define the Anti-Kickback Statute and its purpose c. Explain the intent of HIPAA d. What is anti-trust and how is it regulated 6. NEP a. What is the difference between charity care and community benefit? b. What are the 5 factors that support a hospitals 501(c)(3) tax exempt status...
Someone post from a discussion question... (Respond to it) Medicare is a federal program that provides health coverage if you are 65+ or under 65 and have a disability, no matter your income. Medicaid is a state and federal program that provides health coverage if you have a very low income. Medicaid offers care to the poorest families while CHIP extends coverage to a larger number of children. Care through the Medicaid program may be more extensive, but the CHIP...
Prospective payment system rates are based on the national “average” cost figures. Taking the national average cost into consideration, CMS sets base rates for each PPS. The PPSs then add provisions or adjustments to their system to account for situations where the cost of an individual episode of care or service may be greater or lower than the national average. Pick three provisions or adjustments from PPSs discussed in Chapter 7. Discuss why that provision or adjustment is needed. What...
QUESTION 28 Which specialize in treating individuals with mental health diagnoses? a. behavioral health care hospitals b. general hospitals c. long-term acute care hospitals d. short-term hospitals QUESTION 29 Which admit patients who are diagnosed with trauma or disease and need to learn how to function? a. rehabilitation hospitals b. acute care hospitals c. general hospitals d. specialty hospitals QUESTION 30 Which concentrate on a particular population of patients or diseases. a. general hospitals b. specialty hospitals c. long-term acute...
Please answer the following question as such. How do public reporting and payment incentives affect the quality of care provided by hospitals, physicians and and the following: Pay for performance, ACOs, bundled payment, etc. Role of government / quasi-government sources Medicare Hospital Compare/Nursing Home Compare Pennsylvania Health Care Cost Containment Council Role of non-governmental organizations Joint Commission / NCQA / Leapfrog Group and other collaboratives
The Resource Based Relative Value Scale (RBRVS) is a
prospective payment system established in 1992 by the Centers for
Medicare and Medicaid Services (CMS) designed to improve and
stabilize the payments made to health care providers.
Application Assignment Instructions
Provide a response to the following questions:
1. What are the three types of RVU's?
2. Explain how CMS determines the national conversion factor
for the RBRVS system?
Using the following grid, respond to questions 3-5
below:
3. What is the...