Prospective payment system
Encyclopedia
A prospective payment system (PPS) is a means of determining insurance payments based on predetermined prices, commonly from Medicare
. Payments are typically based on codes provided on the insurance claim.
Examples of these codes include:
Medicare
Medicare may refer to any of several publicly funded health insurance programs:*Medicare *Medicare *Medicare - See also :*Medicaid*Medicare Australia*Medicare Resources - China*Medicare Rights Center - United States...
. Payments are typically based on codes provided on the insurance claim.
Examples of these codes include:
- Diagnosis-related groupDiagnosis-related groupDiagnosis-related group is a system to classify hospital cases into one of originally 467 groups. The 467th was "Ungroupable." The system of classification was developed as a collaborative project by Robert B Fetter, PhD of the Yale School of Management, and John D Thompson, MPH of the Yale...
s – for hospital inpatient claims - Ambulatory Payment Classification – for hospital outpatient claims
- Current Procedural TerminologyCurrent Procedural TerminologyThe Current Procedural Terminology code set is maintained by the American Medical Association through the CPT Editorial Panel. The CPT code set describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among...
– for other outpatient claims
See also
- Medicare Payment Advisory CommissionMedicare Payment Advisory CommissionThe Medicare Payment Advisory Commission is an independent US federal body. MedPAC was established by the Balanced Budget Act of 1997 . Its primary role is to advise the US Congress on issues affecting the administration of the Medicare program...
(MedPAC) - Accountable care organizationAccountable care organizationAn accountable care organization is a type of payment and delivery reform model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients. A group of coordinated health care providers form an ACO, which then...
- Medical classificationMedical classificationMedical classification, or medical coding, is the process of transforming descriptions of medical diagnoses and procedures into universal medical code numbers...