CCA Exam Prep 100+ Questions Solved Correct 100%

CCA Exam Prep 100+ Questions Solved Correct 100% PPS - Prospective Payment System What is prospective payment system? - Payment for all care delivered during an episode of care based on pre-determined fixed amount (DRGs). Influenced by care setting. What are the 4 types of Prospective Payment Systems? - Capitation, global payment method, case-rate methodology, and bundled payment. Capitation - System of payment used by managed care plans in which physicians and hospitals are paid a fixed, per capita amount for each patient enrolled over a stated period regardless of the type and number of services provided; reimbursement to the hospital on a per-member/per-month basis to cover costs for the members of the plan. (PMPM) Global Payment Method - Third-party payer makes one combined payment to cover the services of multiple providers who are treating a single episode of care. Case-Rate Method - Reimburses provider for all services provided during entire encounter or visit, regardless of length of stay. Based on typical costs of condition, and is usually used in inpatient admissions. Bundled Payment - Reimbursement methodology where a predetermined payment amount is provided for all services required for a single predefined episode-of-care. Retrospective payment system -