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Hospital Inpatient Prospective Payment System
and Longer Acute Care Hospital Prospective
Payment System Fiscal Year 2016 Final Rule
Presented by the Center for Medicare and the Center for Clinical
Standards
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How to fill out hospital inpatient prospective payment
How to fill out hospital inpatient prospective payment:
01
Gather all the necessary information such as patient's demographics, admission date, discharge date, and primary diagnosis.
02
Review the medical records and documentation to ensure accurate coding and diagnosis.
03
Determine the appropriate MS-DRG (Medicare Severity Diagnosis Related Group) for the patient based on the diagnosis and procedure codes.
04
Calculate the length of stay and assign the appropriate length of stay outlier if applicable.
05
Determine if any adjustments need to be made for comorbidities or complications.
06
Complete all required forms and documentation accurately, including the UB-04 claim form.
07
Submit the completed claim to the appropriate Medicare Administrative Contractor (MAC) or insurance provider.
Who needs hospital inpatient prospective payment:
01
Hospitals and healthcare facilities that provide inpatient services and are seeking reimbursement for Medicare beneficiaries.
02
Healthcare providers who want to ensure accurate coding and billing practices for inpatient care.
03
Medicare beneficiaries who receive inpatient services and want to understand the payment system and potential costs associated with their care.
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What is hospital inpatient prospective payment?
Hospital inpatient prospective payment is a payment system used by Medicare to reimburse hospitals for services provided to inpatients.
Who is required to file hospital inpatient prospective payment?
Hospitals that provide inpatient services and are reimbursed by Medicare are required to file hospital inpatient prospective payment.
How to fill out hospital inpatient prospective payment?
Hospital inpatient prospective payment is typically filled out using specific forms provided by Medicare that detail the services provided to inpatients.
What is the purpose of hospital inpatient prospective payment?
The purpose of hospital inpatient prospective payment is to provide a standardized method for reimbursing hospitals for inpatient services and to control costs.
What information must be reported on hospital inpatient prospective payment?
Information such as the services provided, diagnoses, procedures, and costs must be reported on hospital inpatient prospective payment forms.
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