Question

Differeniate between the prospective payment system for outpatient, home health, physician, and non- physician practitioners, and ambulatory surgical setting.

Differentiate between the prospective payment systems for outpatient, home health, physician and non-physician practitioners, and ambulatory surgical settings. Reply Reply

Answer 1

#. Prospective payment system where reimbursement is made to the provider based on predetermined reimbursement level rather than on actual charges after the services have been provided .

#. Home Health Prospective Payment System (HHPPS): includes

Home health agencies (HHAs)

Medical services for beneficiaries in their homes

Skilled services ordered by a physician

Covered services

Skilled nursing care

Physical, occupational, and speech therapy

Medical social work

Home health aide

#. Outpatient services paid under other Medicare payment systems

* clinical diagnostic laboratory services

* professional services of physicians and NPPs (PFS)

* screening mammograms

* ambulance services

* physical therapy, occupational therapy, or speech-language therapy services

* durable medical equipment, non-implantable prosthetics, and orthotics (DMEPOS)

*dialysis for end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant) (ESRD composite rate)

* service that requires an inpt stay pd under the hospital Inpatient Prospective Payment System (IPPS)

* Outpatient hospital services from critical access hospitals (CAHs)

* Outpatient services from an Indian Hlth Service (IHS) hospital

* outpatient services from any hospital in Maryland (Maryland hospitals are paid under their state's payment system)

* outpatient services from any hospital located outside of the 50 states, the District of Columbia, and Puerto Rico