Medicare pps payments to hospitals are based on diagnosis related groups (drg). the patient types for whom this applies are?

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24-08-2022
Medicine

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Medicare pps payments to hospitals are based on diagnosis related groups (drg). the patient types for whom this applies are?

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pankajpal6971 pankajpal6971 · Answer 1 · 2022-08-31T12:39:36+02:00

The patient types for whom this applies is to both outpatients and inpatients.

Prospective Payment System (PPS) : It is a reimbursement method in which Medicare payment is made based on a predetermined amount. The CMS uses separate payment systems for reimbursement to

acute inpatients
home health agencies
hospice
outpatients, etc,.

This was implemented by the CMS to control the cost of hospital inpatient care.

Diagnosis Related Group system (DRG System) : In this system the insurer pays the provider hospital for a diagnosis or procedure rather than the number of days of stay in the hospital. This lead to decrease in length of stay , but increased the outpatient services, and efficiency of treatments and procedures.

So we can conclude that , even though both outpatients and inpatients gets the PPS payments, it significantly reduced unnecessary hospital stays and also enhanced the quality of treatments.

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