Various prospective payment systems resemble each other because they are all based on reimbursement, which helps cover the expenses associated with caring for the patients. The most important principle associated with these systems is that the payment is pre-agreed and is identified on the basis of the evaluation of the particular procedures and operations (Harrington, 2021). In addition, the specific classification structure helps to analyze these procedures and determine which can be covered by the system. Although these payment methods have similar features, they also differ in their fundamental components taken into account during their application and the requirements that regulate them.
In the outpatient prospective payment system, the payment unit is the particular service provided to the patients. The separate indicators are used as the classification system to define whether the service can be paid under this program. These indicators refer to the level of sophistication of the procedure. Besides, the geographic varieties influence the level of reimbursement because the additional costs differ in various regions of the country (Harrington, 2021). The calculation of the expenses is based on assessing a collection of procedures and factors that may influence the costs.
The home health prospective payment system, on the other hand, is based on the principle that all the procedures should follow the requirements associated with home care. Such stages as the discharging from acute care, the first home visit, the presentation of a plan of care, and the introduction of certification play a significant role in the decision about the payment (“Home Health,” 2021). Also, according to this system, a refund occurs when the circumstances demand it. When the case happens, the home health agency receives payment for the whole course of treatment, which includes various types of care. These amounts are divided into two parts. The first is provided when the case is identified. The second is supplied when the 60 days of treatment are completed.
The physician payment system differs because it is based on the relative value component, which helps identify the resources needed to accomplish the task. Such elements of the service as the competence of the healthcare worker, the time required for the performance of the healthcare practice, and the quality of equipment, play a significant role in the assessment process (Harrington, 2021). The working hours, the difficulty of the tasks, and the stressfulness are also considered in evaluating the physicians’ salaries.
Non-physician prospective payment system contrasts with the other systems by assessing the healthcare suppliers’ resources to help the patients. This procedure differs from the others because it requires specific attention to the administrative costs and the additional expenses that the office managers usually have during their work with the clients (Harrington, 2021). Besides, it differs because when the non-physician specialist provides service accompanying a physician, these costs are considered a single amount and may not demand bill Medicare independently.
The specifics of the ambulatory surgical settings are that the payment is made based on the evaluation of the procedures. Centers for Medicare and Medicaid Services decide which processes can be covered, and since 2008 its list has increased (Harrington, 2021). Mainly, it includes those operations that are not risky and are urgent for the patients. This system differs from the others because the record is reconsidered more frequently, every quarter, which helps monitor the procedures’ appropriateness. At the same time, the institution that receives the payment should also be certified accordingly to correspond to the standards of the healthcare system.
References
Harrington, M. (2021). Health care finance and the mechanics of insurance and reimbursement (2nd ed.). Jones & Bartlett Learning.
Home Health PPS | CMS. Cms.gov. (2021). Web.