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Rev Cycle Final QuestionAnswerWhich of the following is NOT a provision of the IPPS?Length of stay outlierUnder the IPF PPS which states are included in the cost of living adjustment (COLA)?Alaska and HawaiiWhich of the following is NOT a patient level adjustment used in the IPF PPS?Full service emergency department182 more rows
This is known as the hospital market basket. The IPPS pays hospitals for services provided to Medicare beneficiaries using a national base payment rate, adjusted for a number of factors that affect hospitals costs, including the patients condition and the cost of hospital labor in the hospitals geographic area.
The current measure set for the Hospital OQR Program includes measures that assess processes of care, imaging efficiency patterns, care transitions, ED throughput efficiency, the use of health information technology, care coordination, patient safety, and volume.
A Prospective Payment System (PPS) is a method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount. The payment amount for a particular service is derived based on the classification system of that service (for example, diagnosis-related groups for inpatient hospital services).
A method of reimbursement for the costs of inpatient hospital cases where Medicare payment is made based on predetermined, fixed rates (42 U.S.C. 1395ww). The prospective payment rate is based on a classification system tied to the services provided.

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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.
The CMS finalized an increase to FY 2023 operating payment rates of 4.3% for general acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful electronic health record (EHR) users.
Rather than validating cost increases by reimbursing hospitals for the costs that they have incurred, the Medicare prospective payment system (PPS) allows the Federal Government to become a more prudent purchaser of hospital care by paying a fixed price for a known and defined productthe hospital stay.

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