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Learn what a prospective payment system (PPS) is and how it works for different Medicare services. Find links to each specific PPS and zip code to carrier locality file.
- HIPPS Codes
This page contains information related to the use and...
- Provider Specific Data for Public Use in Text Format
The Medicare Administrative Contractor maintains the...
- Provider Specific Data for Public Use in SAS Format
The Medicare Administrative Contractor maintains the...
- Historical Provider Specific Data for Public Use File in CSV Format
To export specific historic PSF data, please navigate to the...
- Acute Inpatient PPS
This payment system is referred to as the inpatient...
- Ambulatory Surgical Center (ASC) Payment
The Outpatient Prospective and Ambulatory Surgical Center...
- End Stage Renal Disease (ESRD) Prospective Payment System (PPS)
ESRD: CY 2025 Proposed Rule – Submit Comments by August 26....
- Federally Qualified Health Center PPS
Section 10501 of the Patient Protection and Affordable Care...
- HIPPS Codes
A prospective payment system ( PPS) is a term used to refer to several payment methodologies for which means of determining insurance reimbursement is based on a predetermined payment regardless of the intensity of the actual service provided.
2 paź 2023 · By creating predictability in payments, a prospective payment system helps healthcare providers manage their finances and avoid the financial strain of unexpected payments.
Some common characteristics of Medicare PPS are: Prepayment amounts cover defined periods (per diem, per stay, or 60-day episodes). The payment amount is based on a unique assessment classification of each patient. Applies only to Part A inpatients (except for HMOs and home health agencies).
This Medicare Payment Systems educational tool explains how each service type payment system works. A Prospective Payment System (PPS) refers to several payment formulas when reimbursement depends on predetermined payment regardless of the intensity of services provided.
31 sty 2018 · A Prospective Payment System (PPS) is a method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount. The payment amount for a particular service is derived based on the ification system of that service (for example, diagnosis-related groups for inpatient hospital services).
The Inpatient Prospective Payment System (IPPS) is the payment system through which the Centers for Medicare and Medicaid Services (CMS) reimburses short-term acute care hospitals (STACHs) for inpatient services delivered under Medicare Part A to Medicare Fee-for-Service patients.
