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A prospective payment system (PPS) is a term used to refer to several payment methodologies for which means of determining insurance reimbursement is based on a predetermined payment regardless of the intensity of the actual service provided. It includes a system for paying hospitals based on predetermined prices, from Medicare.
By 2001, "case rates for episodes of illness" (bundled payments) were recognized as one type of "blended payment method" (combining retrospective and prospective payment) along with "capitation with fee-for-service carve-outs" and "specialty budgets with fee-for-service or 'contact' capitation."
The two methods yield identical results (assuming bases are the same for both prospective and retrospective calculations). As an example, consider a whole life insurance policy of one dollar issued on (x) with yearly premiums paid at the start of the year and death benefit paid at the end of the year.
Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
In economics and business decision-making, a sunk cost (also known as retrospective cost) is a cost that has already been incurred and cannot be recovered. [ 1 ] [ 2 ] Sunk costs are contrasted with prospective costs , which are future costs that may be avoided if action is taken. [ 3 ]
Fee-for-service (FFS) is a payment model where services are unbundled and paid for separately. [1]In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care.
Celebrating the Crunch Factor. As desserts like crème brûlée and those pleasant crunchy flecks in aged cheeses (technically called “tyrosine crystals”) prove, a crunchy element in an ...
The prospective payment system implemented as DRGs had been designed to limit the share of hospital revenues derived from the Medicare program budget. [11] In 1982 the US Congress passed Tax Equity and Fiscal Responsibility Act with provisions to reform Medicare payment, and in 1983, an amendment was passed to use DRGs for Medicare, [ 7 ] : 16 ...