Medicare Payment System Provisions

Discussion: Medicare Payment System Provisions
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Medicare Payment System Provisions (Level 4—Analyzing)
Prospective payment system rates are based on national “average” cost figures. Taking the national average cost into consideration, CMS sets base rates for each payment system. The payment systems then add provisions or adjustments to the system to account for situations where the cost of an individual encounter or service may be higher or lower than the national average.
Pick three provisions from the Medicare Hospital Outpatient Payment System discussed in chapter 7.
Discuss why each provision is needed.
What would happen if the provision were discontinued?
How would this impact facilities or providers?
How would this impact the Medicare beneficiary?
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