MRHI Introduction to Revenue Cycle. Analyze the differences and similarities bet

Question

MRHI Introduction to Revenue Cycle. Analyze the differences and similarities between prospective payment models. Evaluate how code sets are used to create the reimbursement methodology of each model. rospective Payment System (PPS) is a method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount. The payment amount for a particular service is derived based on the classification system of that service (for example, diagnosis-related groups for inpatient hospital services).

Explanation / Answer

In healthcare bundled payment models, service providers and payers work on two main strategies: prospective or retrospective bundles.

Similarities and Differences:-

Prospective Payment Systems-

Retrospective Payment Systems-

Reimbursement is based upon:

2. Grouper: a software program that applies appropriate logic to assign a particular payment group

3. Data entry software: for the establishment of a database and data transmission

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