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Effect of Medicaid Payment on Rehabilitation Care for - Centers for - cms

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The document examines the impact of Medicaid payment methods and reimbursement rates on rehabilitation therapy delivery for nursing home residents from 1992 to 1995 across six states. It finds that transitioning from prospective facility-specific (PFS) to prospective case-mix adjusted (PCM) payment systems significantly increased the likelihood and intensity of rehabilitation therapy for Medicaid residents. The study highlights the role of government payment structures in influencing care quality and suggests that while PCM payments improve therapy access, further research is needed to assess their effects on resident outcomes.

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How does the Centers for Medicare and Medicaid Services CMS define a care transition?

Care transitions occur when a patient moves from one health care provider or setting to another.

How does the Centers for Medicare and Medicaid Services CMS Inpatient Prospective Payment System IPPS determine payments?

Under the IPPS, each case is categorized into a diagnosis-related group (DRG). Each DRG has a payment weight assigned to it, based on the average resources used to treat Medicare patients in that DRG. The base payment rate is divided into a labor-related and nonlabor share.

How is DRG payment calculated?

How Payment Amounts Are Set. To determine DRG payment amounts, Medicare calculates the average cost of the resources needed to treat people in a particular DRG. This base rate is then adjusted based on various factors, including the wage index for a given area.

What is the payment methodology for ipps?

Under the IPPS, Medicare payment for hospital inpatient operating and capital-related costs is made at predetermined, specific rates for each hospital discharge. Discharges are classified ing to a list of Medicare Severity Diagnosis Related Groups (MS-DRGs).

Does Medicaid pay for physical therapy in long-term care?

Medicaid covers health services for millions of Americas most vulnerable patient populations, including those who depend on physical therapy.

What are the responsibilities of the Centers for Medicare and Medicaid Services CMS?

The Centers for Medicare and Medicaid Services (CMS) provides health coverage to more than 100 million people through Medicare, Medicaid, the Childrens Health Insurance Program, and the Health Insurance Marketplace.

How does IPPS determine reimbursement?

Under the IPPS, each case is categorized into a diagnosis-related group to determine the base rate. Payment also is adjusted for differences in area wage costs -- and depending on the hospital and case -- teaching status, high percentage of low-income patients, the use of new technology and extremely costly cases.

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