Unraveling Medicare's prospective payment system for hospital outpatient care.
This article explains the construction and principal components of Medicare's new hospital outpatient prospective payment system. Examples illustrate the calculation of the payment rates and other amounts that hospitals are paid under the new system. The article concludes with observations about the new system's construction, and operational steps hospitals will likely take to comply with its reporting requirements and optimize Medicare payments.
Grimaldi
P L
PL
Birch & Davis Health Management Corp, Silver Spring, Maryland, USA.
D000368:Aged; D000553:Ambulatory Care / Q000145:classification* / Q000191:economics; D000556:Ambulatory Surgical Procedures / Q000145:classification / Q000191:economics; D003361:Cost Allocation / Q000379:methods; D003953:Diagnosis-Related Groups / Q000145:classification / Q000191:economics; D005245:Fee Schedules; D006801:Humans; D007344:Insurance Claim Reporting; D006278:Medicare / Q000191:economics*; D010044:Outpatient Clinics, Hospital / Q000191:economics*; D011445:Prospective Payment System; D014481:United States