Classification & reimbursement – medicare payment system provisions | classification and reimbursement | Rutgers University – Newark

Medicare Payment System Provisions (THE ATTACHED FILE IS THE BOOK PAGE 114-115 FOR THE QUESTIONS BELOW)

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Prospective payment system rates are based on national “average” cost figures. Taking the national average cost into consideration, CMS sets base rates for each payment system. The payment systems then add provisions or adjustments to the system to account for situations where the cost of an individual encounter or service may be higher or lower than the national average.

Pick three provisions from the Medicare Hospital Outpatient Payment System discussed in chapter 7.

Remember to use a source (even if it’s the textbook) 

  • Discuss why each provision is needed.
  • What would happen if the provision were discontinued?
  • How would this impact facilities or providers?
  • How would this impact the Medicare beneficiary?

the 5 options of provisions to pick are: 

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1. interrupted services

2. high-cost outlier

3. rural hospital adjustment

4. cancer hospital adjustment

5. pass-through payment policy

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