Quiz 3 Flashcards
What is Prospective Payment System (PPS)
reimbursement in which Medicare payment is predetermined and fixed based on DRG
payment for service is based on the classification system of that service
Medicare Payment for acute inpatient care
aka inpatient prospective payment system
cases categorized into a DRG and payment is assigned to it
What is a DRG
diagnostic related group
all costs are paid from a finite pot of money
What do DRGs help emphasize
efficiency
cost containment
protocols
timely discharge or transfer to outpatient services
What is a comprehensive care for joint preplacement (CJR) model
a unique bundled payment for THA, TKA
inpatient stay and all related providers are bundled under a single payment
How are inpatient rehab facilities paid
under a Case-mix Group (CMG) system
system determines the resources needed by an average inpatient rehab case
Reimbursement for SNF
Medicare Part A
PDPM
Medicare Part A in SNF
covers stay for 100 days if all conditions are met
How were SNFS paid before?
PPS and RUGs
reimbursement was driven by the amount of therapy provided
What is Prospective payment system (PPS)
Pays a fixed rate in advance
covers all costs related to services under Medicare A
What is Resource Utilization Groups (RUGs)
Based on 108 items on an assessment of the resident
resident is assigned to one of 7 categories based on clinical characteristics and functional abilities
What is the patient driven payment model (PDPM)
Payment based on clinical characteristics rather than how much service is provided
