Question

Differentiate between the prospective payment systems for outpatient, home health, physician and non-physician practitioners, and ambulatory surgical settings. In your response ensure that you compare and contrast payment systems for each of the categories listed. (600 words)

Answer 1

#. The Outpatient Prospective Payment System (OPPS) is the system through which Medicare decides how much money a hospital or community mental health center will get for outpatient care to patients with Medicare.

#. 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

HHAs :-

Provide skilled care in patient's homes.

Types of HHAs :-

1. HHAs may be free standing or based in hospitals or other healthcare organizations

2. About 85 percent of HHAs are free standing

3. HHAs must be licensed per state or local law

4. Medicare-certified HHAs must meet and comply with Conditions of Participation

5. More than 11,400 HHAs.

#. Ambulatory payment classification (APC) :

Hospital Outpatient Prospective Payment System (HOPPS). The classification is a resource-based reimbursement system. The payment unit is the ambulatory payment classification group (APC group)

Ambulatory surgical center (ASC) :

Freestanding outpatient facility in which outpatient surgeries are performed

Ancillary services :

Professional healthcare services such as radiology, laboratory, or physical therapy

Ambulatory surgery center list of covered procedures (ASC list) :

Procedures that Medicare will cover when they are performed in the ambulatory setting.