Prospective Payment Systems

Prospective Payment Systems

by Duane C. Abbey
Released February 2012
Publisher(s): Productivity Press
ISBN: 9781439873021

Read it now on the O’Reilly learning platform with a 10-day free trial.

O’Reilly members get unlimited access to books, live events, courses curated by job role, and more from O’Reilly and nearly 200 top publishers.

Start your free trial

Book description

The third book in the Healthcare Payment Systems series, Prospective Payment Systems examines the various types of prospective payment systems (PPS) used by healthcare providers and third-party payers. Emphasizing the basic elements of PPS, it considers the many variations of payment for hospital inpatient and outpatient services, skilled nursing facilities, home health agencies, long-term hospital care, and rehabilitation facilities along with other providers.

The book describes the anatomy of PPS, including cost reports, adjudication features and processes, relative weights, and payment processes. It outlines the features and documentation requirements for Medicare Severity Diagnosis Related Groups (MS-DRGs), the Medicare Ambulatory Payment Classifications (APCs), Medicare HHPPS, Medicare Skilled Nursing Resource Utilization Groups (RUGs), and private third-party payers.

  • Provides a framework for understanding and analyzing the characteristics of any PPS
  • Discusses Medicare prospective payment systems and approaches
  • Includes specific references to helpful resources, both online and in print
  • Facilitates a clear understanding of the complexities related to PPS—covering specific topics at a high level and revisiting similar topics to reinforce understanding

Complete with a detailed listing of the acronyms most-commonly used in healthcare coding, billing, and reimbursement, the book includes a series of case studies that illustrate key concepts. It concludes with a discussion of the challenges with PPS—including compliance and overpayment issues—to provide you with the real-world understanding needed to make sense of any PPS.

Table of contents

  1. Front Cover (1/2)
  2. Front Cover (2/2)
  3. Dedication and Acknowledgments
  4. Contents
  5. Preface (1/2)
  6. Preface (2/2)
  7. About the Author
  8. Chapter 1: Introduction to Prospective Payment Systems (1/2)
  9. Chapter 1: Introduction to Prospective Payment Systems (2/2)
  10. Chapter 2: Healthcare Provider Concepts (1/3)
  11. Chapter 2: Healthcare Provider Concepts (2/3)
  12. Chapter 2: Healthcare Provider Concepts (3/3)
  13. Chapter 3: Anatomy of a Prospective Payment System (1/5)
  14. Chapter 3: Anatomy of a Prospective Payment System (2/5)
  15. Chapter 3: Anatomy of a Prospective Payment System (3/5)
  16. Chapter 3: Anatomy of a Prospective Payment System (4/5)
  17. Chapter 3: Anatomy of a Prospective Payment System (5/5)
  18. Chapter 4: Medicare Severity Diagnosis Related Groups (MS-DRGs) (1/7)
  19. Chapter 4: Medicare Severity Diagnosis Related Groups (MS-DRGs) (2/7)
  20. Chapter 4: Medicare Severity Diagnosis Related Groups (MS-DRGs) (3/7)
  21. Chapter 4: Medicare Severity Diagnosis Related Groups (MS-DRGs) (4/7)
  22. Chapter 4: Medicare Severity Diagnosis Related Groups (MS-DRGs) (5/7)
  23. Chapter 4: Medicare Severity Diagnosis Related Groups (MS-DRGs) (6/7)
  24. Chapter 4: Medicare Severity Diagnosis Related Groups (MS-DRGs) (7/7)
  25. Chapter 5: Ambulatory Payment Classifications (APCs) (1/11)
  26. Chapter 5: Ambulatory Payment Classifications (APCs) (2/11)
  27. Chapter 5: Ambulatory Payment Classifications (APCs) (3/11)
  28. Chapter 5: Ambulatory Payment Classifications (APCs) (4/11)
  29. Chapter 5: Ambulatory Payment Classifications (APCs) (5/11)
  30. Chapter 5: Ambulatory Payment Classifications (APCs) (6/11)
  31. Chapter 5: Ambulatory Payment Classifications (APCs) (7/11)
  32. Chapter 5: Ambulatory Payment Classifications (APCs) (8/11)
  33. Chapter 5: Ambulatory Payment Classifications (APCs) (9/11)
  34. Chapter 5: Ambulatory Payment Classifications (APCs) (10/11)
  35. Chapter 5: Ambulatory Payment Classifications (APCs) (11/11)
  36. Chapter 6: Other Prospective Payment Systems (1/5)
  37. Chapter 6: Other Prospective Payment Systems (2/5)
  38. Chapter 6: Other Prospective Payment Systems (3/5)
  39. Chapter 6: Other Prospective Payment Systems (4/5)
  40. Chapter 6: Other Prospective Payment Systems (5/5)
  41. Conclusion and Endnote
  42. Appendix A: Case Studies (1/4)
  43. Appendix A: Case Studies (2/4)
  44. Appendix A: Case Studies (3/4)
  45. Appendix A: Case Studies (4/4)
  46. Appendix B: Acronyms (1/2)
  47. Appendix B: Acronyms (2/2)
  48. Back Cover

Product information

  • Title: Prospective Payment Systems
  • Author(s): Duane C. Abbey
  • Release date: February 2012
  • Publisher(s): Productivity Press
  • ISBN: 9781439873021