5 nuances of Medicare billing.

HOSPITAL prospective payment; PROSPECTIVE payment systems; HOSPITAL outpatient prospective payment; MEDICARE; MEDICAL care; DIAGNOSIS related groups; HEALTH policy; NATIONAL health insurance

The article offers information on the five commonly misunderstood components of inpatient and outpatient prospective payment systems in the U.S. According to the author, severity-adjusted diagnoses-related groups (DRGs) has been agreed by most healthcare finance professionals as a logical evolution of the case rate prospective payment system (PPS). He added that providers must group claims under MS-DRG on "bill drop", investigate the possibility of attaining critical access hospital and identify managed contracts that pay therapies from physician schedule to ensure appropriate Medicare payment.