Create an account
Five types of reimbursement
1.Fee-for-service 2. Discount fee-for-Service3. Prospective Payment System (PPS) 4. Managed care organizations 5. Capitation
When the provider agrees,through a contractual agreenment, not to be paid the remaining amount of a fee after a patient has paid their deductible and coinsurance and all third party payers have paid their share
Three primary reimbursement systems used by Medicare:
1.Prospective Payment Systems (PPS) 2. Fee-Schedules 3. Medicare Avantage
PPS rates are set to cover costs for treating a typical inpatient in a given DRG
a. Hospital are psid a set fee for treating patients in a single DRG category. b.) There are PPS variations for different helthcare settings e.g. LTCH PPS, HH PPS, I PPS, RUGs
Five systems for determining reimbursment
1. RVS relative value scales (RVS) 2. Resource-based Relative Value Scales (RBRVS) 3. Diagnosis Related Groups 4. (DRG) Ambulatory Payment Classification (APC) 5. Resource utilization Groups (RUG)
RBRVS were adopted under which federal legislature?
(OBRA) Omnibus Budget Reconciliation Act of 1989
Please allow access to your computer’s microphone to use Voice Recording.
Having trouble? Click here for help.
We can’t access your microphone!
Click the icon above to update your browser permissions and try again
Reload the page to try again!Reload
Press Cmd-0 to reset your zoom
Press Ctrl-0 to reset your zoom
It looks like your browser might be zoomed in or out. Your browser needs to be zoomed to a normal size to record audio.
Please upgrade Flash or install Chrome
to use Voice Recording.
For more help, see our troubleshooting page.
Your microphone is muted
For help fixing this issue, see this FAQ.
Star this term
You can study starred terms together