Which prospective payment system reimburses providers according to predetermined rates for a 60-day episode of care?

Which prospective payment system reimburses providers according to predetermined rates for a 60-day episode of care?

• A. Home health resource groups
• B. Inpatient rehabilitation facility
• C. Long-term care Medicare severity diagnosis-related groups
• D. The skilled nursing facility prospective payment system

Answer: (A)

The correct answer is that home health resource groups (HHRGs) reimburse providers according to predetermined rates for a 60-day episode of care. Under the Home Health Prospective Payment System (HH PPS), Medicare pays home health agencies a fixed amount for each 60-day episode of care based on the characteristics of the patient, including their clinical and functional status, rather than the specific services provided. This prospective payment system aims to encourage efficiency and improve care delivery by offering a set payment amount for comprehensive services over the episode period. Other options describe different payment systems that do not align with the 60-day episode of care model relevant to home health services. Inpatient rehabilitation facilities, for example, focus on acute rehabilitation services under a different payment structure. Similarly, long-term care and skilled nursing facilities utilize their distinct prospective payment systems linked to various criteria depending on the patient population and the services rendered, which do not conform to the 60-day episode framework used in home health care.

The correct answer is that home health resource groups (HHRGs) reimburse providers according to predetermined rates for a 60-day episode of care. Under the Home Health Prospective Payment System (HH PPS), Medicare pays home health agencies a fixed amount for each 60-day episode of care based on the characteristics of the patient, including their clinical and functional status, rather than the specific services provided. This prospective payment system aims to encourage efficiency and improve care delivery by offering a set payment amount for comprehensive services over the episode period.

Other options describe different payment systems that do not align with the 60-day episode of care model relevant to home health services. Inpatient rehabilitation facilities, for example, focus on acute rehabilitation services under a different payment structure. Similarly, long-term care and skilled nursing facilities utilize their distinct prospective payment systems linked to various criteria depending on the patient population and the services rendered, which do not conform to the 60-day episode framework used in home health care.