Inpatient reimbursement
What is PPS? - answer Prospective Payment System (PPS) is a method of
reimbursement in which Medicare payment is made based on a predetermined, fixed
amount.
Medicare PPS reimburse hospitals how for inpatient stay? - answer flat amount for an
inpatient stay (discharge)
DRG is? - answer Diagnosis related group
Payment of DRG's include the estimated resources of: - answer- Nursing
- medication and supplies
- operating room and lab
- facility and maintenance
- other clinical and support staff
- devices
- intensive care unit
- administration
True or false:
Standard DRG payment does not change based on length of stay or hospital charges -
answertrue
Why would hospitals want to keep cost below DRG payment? - answer they get to keep
the gains of saved cost. Vice versa they also take the loss if cost exceed DRG payment.
Hospitals receive additional medicare payments if they: - answer- provide graduate
medical education
- serve a disproportionately large share of low-income payment.
Commercial payers (including medicare advantage) offer what instead of DRGs? -
answernegotiated per day rate ("per diem")
IPPS stands for? - answerInpatient prospective payment system
How do IPPS reimburse? - answer- for acute inpatient care via MS-DRGs
- payment amounts set by CMS
What types of stays are covered under medicare IPPS? - answer- psychiatric
- long-term
- rehabilitation
- skilled nursing care
What is PPS? - answer Prospective Payment System (PPS) is a method of
reimbursement in which Medicare payment is made based on a predetermined, fixed
amount.
Medicare PPS reimburse hospitals how for inpatient stay? - answer flat amount for an
inpatient stay (discharge)
DRG is? - answer Diagnosis related group
Payment of DRG's include the estimated resources of: - answer- Nursing
- medication and supplies
- operating room and lab
- facility and maintenance
- other clinical and support staff
- devices
- intensive care unit
- administration
True or false:
Standard DRG payment does not change based on length of stay or hospital charges -
answertrue
Why would hospitals want to keep cost below DRG payment? - answer they get to keep
the gains of saved cost. Vice versa they also take the loss if cost exceed DRG payment.
Hospitals receive additional medicare payments if they: - answer- provide graduate
medical education
- serve a disproportionately large share of low-income payment.
Commercial payers (including medicare advantage) offer what instead of DRGs? -
answernegotiated per day rate ("per diem")
IPPS stands for? - answerInpatient prospective payment system
How do IPPS reimburse? - answer- for acute inpatient care via MS-DRGs
- payment amounts set by CMS
What types of stays are covered under medicare IPPS? - answer- psychiatric
- long-term
- rehabilitation
- skilled nursing care
