Describe the inpatient prospective payment system


Response to EACH question must be a minimum of 200 words:

1. Provide a description of the factors that impact the reimbursement of inpatient services for Medicare. Be certain to include a discussion of the inpatient Prospective Payment System (IPPS), diagnosis related groups (DRGs), and items that must be reported on the hospital health care claim.

2. Proper reimbursement is directly related to accurate coding. Describe two major differences in coding diagnoses for inpatient cases versus physician services. Which classification system is used for coding hospital procedures and how does it impact reimbursement?

3. One crucial factor in healthcare reimbursement is differentiating between inpatient and outpatient services. Provide an explanation of how facilities distinguish between these two services and discuss the major steps relating to hospital billing and reimbursement.

4. Accurate coding is essential to reimbursement and so is proper claim submission. Using the correct forms for claim submission is equally as important. What is the correct form to use for hospital/facility claims? Discuss what information needs to be reported on the claim form to ensure acceptance by the clearinghouse and the insurance company?

 

 

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