Prospective Payment System

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Hhs Centers For Medicare Medicaid Services - One of the best experts on this subject based on the ideXlab platform.

  • medicare program end stage renal disease Prospective Payment System Payment for renal dialysis services furnished to individuals with acute kidney injury end stage renal disease quality incentive program durable medical equipment prosthetics orthotic
    Federal Register, 2018
    Co-Authors: Hhs Centers For Medicare Medicaid Services
    Abstract:

    : This final rule updates and makes revisions to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year (CY) 2019. This rule also updates the Payment rate for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury (AKI). In addition, it updates and rebases the ESRD market basket for CY 2019. This rule also updates requirements for the ESRD Quality Incentive Program (QIP), and makes technical amendments to correct existing regulations related to the Competitive Bidding Program (CBP) for certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS). Finally, this rule finalizes changes to bidding and pricing methodologies under the DMEPOS competitive bidding program; adjustments to DMEPOS fee schedule amounts using information from competitive bidding for items furnished from January 1, 2019 through December 31, 2020; new Payment classes for oxygen and oxygen equipment and a new methodology for ensuring that new Payment classes for oxygen and oxygen equipment are budget neutral; Payment rules for multi- function ventilators or ventilators that perform functions of other durable medical equipment (DME); and revises the Payment methodology for mail order items furnished in the Northern Mariana Islands. This rule also includes a summary of the feedback received for the request for information related to establishing fee schedule amounts for new DMEPOS items and services.

  • medicare program hospital inpatient Prospective Payment Systems for acute care hospitals and the long term care hospital Prospective Payment System and policy changes and fiscal year 2019 rates quality reporting requirements for specific providers me
    Federal Register, 2018
    Co-Authors: Hhs Centers For Medicare Medicaid Services
    Abstract:

    We are revising the Medicare hospital inpatient Prospective Payment Systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these Systems for FY 2019. Some of these changes implement certain statutory provisions contained in the 21st Century Cures Act and the Bipartisan Budget Act of 2018, and other legislation. We also are making changes relating to Medicare graduate medical education (GME) affiliation agreements for new urban teaching hospitals. In addition, we are providing the market basket update that will apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis, subject to these limits for FY 2019. We are updating the Payment policies and the annual Payment rates for the Medicare Prospective Payment System (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2019. In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, and LTCHs). We also are establishing new requirements or revising existing requirements for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs (now referred to as the Promoting Interoperability Programs). In addition, we are finalizing modifications to the requirements that apply to States operating Medicaid Promoting Interoperability Programs. We are updating policies for the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. We also are making changes relating to the required supporting documentation for an acceptable Medicare cost report submission and the supporting information for physician certification and recertification of claims.

  • medicare program Prospective Payment System and consolidated billing for skilled nursing facilities snf final rule for fy 2019 snf value based purchasing program and snf quality reporting program final rule
    Federal Register, 2018
    Co-Authors: Hhs Centers For Medicare Medicaid Services
    Abstract:

    This final rule updates the Payment rates used under the Prospective Payment System (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2019. This final rule also replaces the existing case-mix classification methodology, the Resource Utilization Groups, Version IV (RUG–IV) model, with a revised case-mix methodology called the Patient- Driven Payment Model (PDPM) beginning on October 1, 2019. The rule finalizes revisions to the regulation text that describes a beneficiary's SNF "resident" status under the consolidated billing provision and the required content of the SNF level of care certification. The rule also finalizes updates to the SNF Quality Reporting Program (QRP) and the Skilled Nursing Facility Value-Based Purchasing (VBP) Program.

  • medicare program changes to hospital outpatient Prospective Payment and ambulatory surgical center Payment Systems and quality reporting programs final rule with comment period
    Federal Register, 2017
    Co-Authors: Hhs Centers For Medicare Medicaid Services
    Abstract:

    This final rule with comment period revises the Medicare hospital outpatient Prospective Payment System (OPPS) and the Medicare ambulatory surgical center (ASC) Payment System for CY 2018 to implement changes arising from our continuing experience with these Systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the Payment rates for Medicare services paid under the OPPS and those paid under the ASC Payment System. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program.

  • medicare program Prospective Payment System and consolidated billing for skilled nursing facilities for fy 2018 snf value based purchasing program snf quality reporting program survey team composition and correction of the performance period for the nhsn hcp influenza vaccination immunization reporting measure in the esrd qip for py 2020 final rule
    Federal Register, 2017
    Co-Authors: Hhs Centers For Medicare Medicaid Services
    Abstract:

    This final rule updates the Payment rates used under the Prospective Payment System (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2018. It also revises and rebases the market basket index by updating the base year from 2010 to 2014, and by adding a new cost category for Installation, Maintenance, and Repair Services. The rule also finalizes revisions to the SNF Quality Reporting Program (QRP), including measure and standardized resident assessment data policies and policies related to public display. In addition, it finalizes policies for the Skilled Nursing Facility Value-Based Purchasing Program that will affect Medicare Payment to SNFs beginning in FY 2019. The final rule also clarifies the regulatory requirements for team composition for surveys conducted for investigating a complaint and aligns regulatory provisions for investigation of complaints with the statutory requirements. The final rule also finalizes the performance period for the National Healthcare Safety Network (NHSN) Healthcare Personnel (HCP) Influenza Vaccination Reporting Measure included in the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) for Payment Year 2020.

Jose J Escarce - One of the best experts on this subject based on the ideXlab platform.

  • effects of medicare Payment reform evidence from the home health interim and Prospective Payment Systems
    Journal of Health Economics, 2014
    Co-Authors: Peter J Huckfeldt, Neeraj Sood, Jose J Escarce, David C Grabowski, Joseph P Newhouse
    Abstract:

    Medicare continues to implement Payment reforms that shift reimbursement from fee-for-service toward episode-based Payment, affecting average and marginal Payment. We contrast the effects of two reforms for home health agencies. The home health interim Payment System in 1997 lowered both types of Payment; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The home health Prospective Payment System in 2000 raised average but lowered marginal Payment with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality.

  • effects of medicare Payment reform evidence from the home health interim and Prospective Payment Systems
    2012
    Co-Authors: Peter J Huckfeldt, Neeraj Sood, Jose J Escarce, David C Grabowski, Joseph P Newhouse
    Abstract:

    Medicare continues to implement Payment reforms that shift reimbursement from fee-for-service towards episode-based Payment, affecting average and marginal reimbursement. We contrast the effects of two reforms for home health agencies. The Home Health Interim Payment System in 1997 lowered both types of reimbursement; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The Home Health Prospective Payment System in 2000 raised average but lowered marginal reimbursement with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality.

  • does how much and how you pay matter evidence from the inpatient rehabilitation care Prospective Payment System
    Journal of Health Economics, 2008
    Co-Authors: Neeraj Sood, Melinda Beeuwkes Buntin, Jose J Escarce
    Abstract:

    We use the implementation of a new Prospective Payment System (PPS) for inpatient rehabilitation facilities (IRFs) to investigate the effect of changes in marginal and average reimbursement on costs. The results show that the IRF PPS led to a significant decline in costs and length of stay. Changes in marginal reimbursement associated with the move from a cost-based System to a PPS led to a 7-11% reduction in costs. The elasticity of costs with respect to average reimbursement ranged from 0.26 to 0.34. Finally, the IRF PPS had little or no impact on mortality or the rate of return to community residence.

  • does how much and how you pay matter evidence from the inpatient rehabilitation facility Prospective Payment System
    Social Science Research Network, 2006
    Co-Authors: Neeraj Sood, Melinda Beeuwkes Buntin, Jose J Escarce
    Abstract:

    We use the implementation of a new Prospective Payment System (PPS) for inpatient rehabilitation facilities (IRFs) to investigate the effect of changes in marginal and average reimbursement on costs. The results show that the IRF PPS led to a significant decline in costs and length of stay. Changes in marginal reimbursement associated with the move from a cost based System to a PPS led to a 7 to 11% reduction in costs. The elasticity of costs with respect average reimbursement ranged from 0.26 to 0.34. Finally, the IRF PPS had little or no impact on costs in other sites of care, mortality, or the rate of return to community residence.

Pina C Sanelli - One of the best experts on this subject based on the ideXlab platform.

  • national initiatives for measuring quality performance for the practicing neuroradiologist
    Neuroimaging Clinics of North America, 2012
    Co-Authors: Nikesh Anumula, Pina C Sanelli
    Abstract:

    This article provides an overview of the national initiatives developed for monitoring and reporting quality performance measures. Included is a review of the Physician Quality Reporting System, the Hospital Outpatient Quality Data Reporting Program, and the Hospital Outpatient Prospective Payment System, with specific emphasis on how these programs affect radiology practice. A practical review of these programs allows radiologists to gain further understanding of the economic and political influences on the daily practice of radiology today. The background and relevant features of each program are presented in this article.

  • Hospital Outpatient Prospective Payment System.
    American Journal of Neuroradiology, 2012
    Co-Authors: Nikesh Anumula, Pina C Sanelli
    Abstract:

    SUMMARY: A brief review of the Hospital Outpatient Prospective Payment System (HOPPS) is presented highlighting the program9s legislative history, outpatient service classifications and Payment plan. Specifically, HOPPS measures applicable to imaging practices are discussed. Resources are also provided for further information on the program requirements and the ambulatory Payment classifications (APC) System.

Neeraj Sood - One of the best experts on this subject based on the ideXlab platform.

  • effects of medicare Payment reform evidence from the home health interim and Prospective Payment Systems
    Journal of Health Economics, 2014
    Co-Authors: Peter J Huckfeldt, Neeraj Sood, Jose J Escarce, David C Grabowski, Joseph P Newhouse
    Abstract:

    Medicare continues to implement Payment reforms that shift reimbursement from fee-for-service toward episode-based Payment, affecting average and marginal Payment. We contrast the effects of two reforms for home health agencies. The home health interim Payment System in 1997 lowered both types of Payment; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The home health Prospective Payment System in 2000 raised average but lowered marginal Payment with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality.

  • effects of medicare Payment reform evidence from the home health interim and Prospective Payment Systems
    2012
    Co-Authors: Peter J Huckfeldt, Neeraj Sood, Jose J Escarce, David C Grabowski, Joseph P Newhouse
    Abstract:

    Medicare continues to implement Payment reforms that shift reimbursement from fee-for-service towards episode-based Payment, affecting average and marginal reimbursement. We contrast the effects of two reforms for home health agencies. The Home Health Interim Payment System in 1997 lowered both types of reimbursement; our conceptual model predicts a decline in the likelihood of use and costs, both of which we find. The Home Health Prospective Payment System in 2000 raised average but lowered marginal reimbursement with theoretically ambiguous effects; we find a modest increase in use and costs. We find little substantive effect of either policy on readmissions or mortality.

  • does how much and how you pay matter evidence from the inpatient rehabilitation care Prospective Payment System
    Journal of Health Economics, 2008
    Co-Authors: Neeraj Sood, Melinda Beeuwkes Buntin, Jose J Escarce
    Abstract:

    We use the implementation of a new Prospective Payment System (PPS) for inpatient rehabilitation facilities (IRFs) to investigate the effect of changes in marginal and average reimbursement on costs. The results show that the IRF PPS led to a significant decline in costs and length of stay. Changes in marginal reimbursement associated with the move from a cost-based System to a PPS led to a 7-11% reduction in costs. The elasticity of costs with respect to average reimbursement ranged from 0.26 to 0.34. Finally, the IRF PPS had little or no impact on mortality or the rate of return to community residence.

  • does how much and how you pay matter evidence from the inpatient rehabilitation facility Prospective Payment System
    Social Science Research Network, 2006
    Co-Authors: Neeraj Sood, Melinda Beeuwkes Buntin, Jose J Escarce
    Abstract:

    We use the implementation of a new Prospective Payment System (PPS) for inpatient rehabilitation facilities (IRFs) to investigate the effect of changes in marginal and average reimbursement on costs. The results show that the IRF PPS led to a significant decline in costs and length of stay. Changes in marginal reimbursement associated with the move from a cost based System to a PPS led to a 7 to 11% reduction in costs. The elasticity of costs with respect average reimbursement ranged from 0.26 to 0.34. Finally, the IRF PPS had little or no impact on costs in other sites of care, mortality, or the rate of return to community residence.

Anne Deutsch - One of the best experts on this subject based on the ideXlab platform.

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