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CCA Exam Prep 1.PPS ANS Prospective Payment System 2.What is prospective payment system?ANS Payment for all care delivered during an episode of care based on pre- determined fixed amount (DRGs). Influenced by care setting.
3.What are the 4 types of Prospective Payment Systems?ANS Capitation, global payment method, case-rate methodology, and bundled payment.
4.Capitation ANS System of payment used by managed care plans in which physicians and hospitals are paid a fixed, per capita amount for each patient enrolled over a stat- ed period regardless of the type and number of services provided; reimbursement to the hospital on a per-member/per-month basis to cover costs for the members of the plan. (PMPM) 5.Global Payment Method ANS Third-party payer makes one combined payment to cover the services of 1 / 2
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multiple providers who are treating a single episode of care.
6.Case-Rate Method ANS Reimburses provider for all services provided during entire encounter or visit, regardless of length of stay. Based on typical costs of condition, and is usually used in inpatient admissions.
7.Bundled Payment ANS Reimbursement methodology where a predetermined pay- ment amount is provided for all services required for a single predefined episode-of-care.
8.Retrospective payment system ANS Type of fee-for-service reimbursement in which providers receive recompense after health services have been rendered 9.fee-for-service ANS a system under which doctors and hospitals receive a payment for each service they provide 10.Risk-adjusted payment ANS introduced under ACA, shifts burden of risk for treating high-risk patients to be shared by all insurers. Meant to make premiums the same.
11.ACA