BC Advantage - 2024 Issue 9

Medicare Fee Schedule Information

Medicare fees have become more complex over the years as new systems are implemented to improve quality while reducing costs. The majority of healthcare providers are paid through either the Prospective Payment System (PPS) or the Medicare Fee-for-Service (FFS) system. Some of Medicare's Alternative Payment Models (APMs) and Accountable Care Organization (ACO) programs have different reimbursement systems which are not discussed in this article.   Prospective Payment System (PPS)   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...

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