The Prospective Payment System of CMS
The Prospective Payment System of CMS consists of thirteen schedules that allow the calculation of payment for a patient encounter. The DRG or price-based system covers inpatient charges from one of these schedules.
Tasks:
Describe the schedules of CMS.
Provide an example of a charge for each schedule.
Describe the case mix concept that alters payment rates.
Describe the diagnosis related group payment system.
Sample Solution
CMS schedules vary depending on the school, but most schools follow a six-day cycle with classes meeting every other day. Most days usually include four hours of instruction. School typically begins in late August and ends in early June, with breaks for holidays throughout the year. Many CMS schools also follow a block schedule where students take two or more classes each day for an extended period of time, usually 90 minutes to two hours per class.