Paying for Hospital and Physician Service (Example)

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Paying for Hospital and Physician Service Name Instructor Institution Date Paying for Hospital and Physician Services Introduction Medicare uses Prospective Payment system (PPS) for reimbursement for medical services to beneficiaries. The amount payable is classified according to the type of services offered. For instance Medicare uses some service plans such as Diagnosis-Related Groups (DRGs) for acute hospital care for inpatient needs Home Health Resource Groups (HHRGs) for home health agencies and the Resource-Based Relative Value Scales (RBRVS) for the outpatient services. The paper seeks to explore by calculation the operating payment capital payment outlier payment and the total payment for the hospital through the DRG approach for a kidney transplant. Further calculations on outpatient physician services and the related out-of-pocket associated cost will be presented. The DRG payment system and calculations The DRG approach is used regardless of the actual service provided to the inpatient client. The primary diagnosis for Medicare and Medicaid. (2014). Medicare Physician Fee Schedule. The Medicare Learning Network Payment Systems Fact Sheet Series. Available at www.cms.gov S. Davis K. Stremikis K. & Drake H. (2010). Innovation in Medicare and Medicaid Will Be Central to Health Reform's Success. Health Affairs 29 (6) 1188-93. Retrieved from ProQuest on 11/21/2012. Lesser C. Fineberg H. & Cassel C. (2010). Physician Payment Reform: Principles That Should Shape It. Health Affairs 29 (5) 948-952. Retrieved from ProQuest on 11/21/2012. Wilensky G. (2009). Reforming Medicare's Physician Payment System. New England Journal of Medicine 360 (7) 653-655.  This item is available in full text via the University library. Medicare Payment Advisory Commission. (2016). Medicare Payment Basics:  Hospital Acute Inpatient Services Payment System. Available at: www.medpac.gov Payment Advisory Commission. (2014). Medicare Payment Basics: Outpatient Hospital Services Payment System. Available at www.medpac.gov University module four notes (n.d.). Paying For Hospital and Physician Services. Retrieved September 24 2016 from tlc.trident.edu . [...]

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