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The third book within the Healthcare Payment Systems collection, Prospective Payment Systems examines the varied kinds of potential cost methods (PPS) utilized by healthcare suppliers and third-get together payers. Emphasizing the essential parts of PPS, it considers the various variations of cost for hospital inpatient and outpatient providers, expert nursing amenities, house well being businesses, long-time period hospital care, and rehabilitation amenities together with different suppliers.
The book describes the anatomy of PPS, together with value reviews, adjudication options and processes, relative weights, and cost processes. It outlines the options and documentation necessities for Medicare Severity Analysis Associated Teams (MS-DRGs), the Medicare Ambulatory Payment Classifications (APCs), Medicare HHPPS, Medicare Expert Nursing Useful resource Utilization Teams (RUGs), and personal third-get together payers.
Offers a framework for understanding and analyzing the traits of any PPS
Discusses Medicare potential cost techniques and approaches
Consists of particular references to useful assets, each on-line and in print
Facilitates a transparent understanding of the complexities associated to PPS—overlaying particular subjects at a high degree and revisiting comparable subjects to strengthen understanding
Full with an in depth itemizing of the acronyms most-generally utilized in healthcare coding, billing, and reimbursement, the book features a collection of case research that illustrate key ideas. It concludes with a dialogue of the challenges with PPS—together with compliance and overpayment points—to give you the actual-world understanding wanted to make sense of any PPS.
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