week four.docx - With prospective payments systems there is an assigned fixed payment rate that is applied to specific treatments(Staff 2016 So what

week four.docx - With prospective payments systems there is...

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With prospective payments systems there is an assigned fixed payment rate that is applied to specific treatments (Staff, 2016). So what this basically means is that no matter what a provider will be reimbursed the same amount for the same type of service. This payment amount does not vary from patient to patient. With a non-prospective payment system insurances reimburse a provider on their individual services. When non-prospective payment in in play a provider treats a patient and then an itemized claim is submitted to the insurance company (Staff, 2016). This means the reimbursement rate varies from patient to patient. One of the differences between a prospective payment system and a non-prospective payment system is the reimbursement rate. CMS.gov states that a prospective payment system is where Medicare will pay a fixed amount (CMS, 2019). Due to the fact that a PPS has a fixed payment rate providers may perform more efficient care on a patient because they are only receiving one payment rate no matter what. This eliminates unnecessary services.
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  • Fall '19
  • Centers for Medicare and Medicaid Services, PPS, Prospective Payments Systems

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