There are various prospective payment systems for outpatient, home health, physician and nonphysician practitioners, and ambulatory...

There are various prospective payment systems for outpatient, home health, physician and nonphysician practitioners, and ambulatory surgical settings.

Instructions:

Identify two unique prospective payment systems and describe the facility types each of your selected systems are used for.

How are the unique differences in your two identified systems utilized in reimbursement? Provide an example to support your answer.

Why are all payment systems not the same? Provide an example to support your answer.

Expert Solution

Prospective payment system is described as payment system to determine insurance reimbursement based on pre-determine payment for actual service provided..PPS used by basically from health care providers and third-party payers..It has many variations of payments for inpatient,outpatient, skilled nursing facillities,home health agencies,long-term care and rehabilitation facilities with providers..
   Home health:
?    Medicare pays for home health agencies under prospective payment system..It is a predetermined payment system.It provides payment for patient health condition and care they needs..There are no limits for this.The home health PPS provides for each beneficiary..End of the first episodes escond episodes can begin for eligible care..The full payment in the initial percentage unless there is an applicable adjustment..
? This will be estimated according to patient condition and the care they needs..This split percentage payment and balanced cash flow for HHAs..After 60days episode can be applicable for long stay patients..Annual payment totally estamated is not more than 2.5%..Low utilization payment adjustment for four or fewer visit.This will save from reduced payment systems can be redistributed to all episodes under the PPS..
?    The PPS rate will include all services and medical supplies and medical social services..The centers for medicare and medicaid services(CMS) having problem in HH PPS rates and wage index year 2018..Medicare reimbursement 1%dropped in 2018.In 2017 the proposed rate was 180million dollar it will be less in next year.The CMS applied 3%annual payment reduction or increase in nine states but it increase to 8% in 2022..
Out patient PPS:
?    The basic rule for this OPPS and medicare Ambulatory Surgical Center(ASC) payment system needs continuing experience to arise changes in requirements..The changes for amounts and factors to determine the payment rates for medicare service paid under OPPS..This need requirement for the hospital outpatient Quality Report(OQR)program and the ASC Quaity Report program..For example in the hospital Outpatient outpatient environment imaging is not paid seperately when reports with service delivery..Packaged services do not receive seperate payment.The total outier payement at 1.0% of total OPPS payments..It continue to pay 50% of the amount hospital cost exceeds 1.75times the APC payment amount..
?    All the payemnt systems are not same the acute in patient payement provides an manage the costs of inputs needed for care..The hospitals managing th cost by eliminating unneccessary services..Same like inpatient outpatient system services similar cost wise 850 ambulatory payment classification(APC)categaries..
?    Skilled nursing facilities PPS will cover all the routine services and care..it differ for high cost ancillary services For example ventilator and tracheostomy care etc..
? Home health PPS depends the number of case provided for medicare patients..According to number of visits the cost -based payment provided a transition to prospective payemnt..
? Outpatient dialysis services will receive larger part payment that cover the dialysis treatment and samall part of drugs suppliments and lab tests..according to home dialysis,hospital dialysis payment will be differ 4 dollar per treatment..
? Physicians medicare pays for medical professionals who can give treatement and service provided directly to patient..
?

Nightingale answered 2 years ago

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

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)

Outpatient Payment Systems There are various prospective payment systems for outpatient, home health, physician and nonphysician...

Outpatient Payment Systems There are various prospective payment systems for outpatient, home health, physician and nonphysician practitioners, and ambulatory surgical settings. Instructions: Identify two unique prospective payment systems and describe the facility types each of your selected systems are used for. How are the unique differences in your two identified systems utilized in reimbursement? Provide an example to support your answer. Why are all payment systems not the same? Provide an example to support your answer.

The use of non-physician clinicians mainly nurse practitioners and physician assistants in ambulatory care is increasing....

The use of non-physician clinicians mainly nurse practitioners and physician assistants in ambulatory care is increasing. Should these two types of clinicians be allowed to practice independently or should they remain under the supervision of a board certified physician. What are the strengths and pitfalls of each road.

QUESTION 1 Under the Hospital Outpatient Prospective Payment System (OPPS), payments for services are: A.paid on...

QUESTION 1 Under the Hospital Outpatient Prospective Payment System (OPPS), payments for services are: A.paid on a fee-for-service basis B.set in advance C.discounted from provider customary fees D.based of physician billed charges 10 points QUESTION 2 Which paper and electronic claims forms are used by hospitals and ambulatory surgery centers to reflect institutional (facility) charges? A.CMS 1500 or 837P B.UB-92 or 837P C.UB-04 or 837I D.CMS 1500 or ABN 10 points QUESTION 3 The excision of benign or malignant lesions...

Compare the health systems of various countries.

1 Third Party Payment for health care is provided by the Patient Physician Pharmaceutical Companies Health...

1 Third Party Payment for health care is provided by the Patient Physician Pharmaceutical Companies Health Insurance Companies 2 Which of the following is NOT one of the nine major factors contributing to high costs of health care Third-party payment Imperfect market Lack of growth in technology Increase in elderly population 3 A Premium in Health Insurance Is part of the deductible Is part of the co-payment Is the amount charged by the insurer to insure against specific risks Is...

A 41-year-old woman presents to an outpatient mental health clinic on referral by her family physician....

A 41-year-old woman presents to an outpatient mental health clinic on referral by her family physician. She has complaints, signs, and symptoms indicative of a major depressive episode with melancholic features. She has undergone treatment for alcoholism within the last year. She is experiencing severe family stressors, namely, her children have moved out of the home. She is already receiving antidepressant therapy, mirtazapine, prescribed by her family physician, without improvement, and complains of weight gain as a side effect. To...

Suppose a physician receives a fixed payment () for providing health care services to a patient...

Suppose a physician receives a fixed payment () for providing health care services to a patient and there is a probability of the patient incurring iatrogenic injury (θ) that causes monetary loss to the patient (). Assume that the patient’s monetary loss is fixed once the injury has occurred. However, the probability of injury depends on the physician's level of care (e, for effort). That is, θ = θ(e). The probability of injury decreases as the level of physician care...

Consider the various data elements that would be gathered for prospective health insurance customers. Think about...

Consider the various data elements that would be gathered for prospective health insurance customers. Think about other situations which could be developed to target customers and the associated structured decisions. Discuss the data that could be collected.

Craig's health insurance has no deductible and $15 co-payment for all physician visits and $25 for...

Craig's health insurance has no deductible and $15 co-payment for all physician visits and $25 for all labs. Craig goes to the local laboratory for a blood draw on January 1st. The bill was $80. How much will Craig pay for the visit?

Question