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Under the current Medicare system, patients can get post-acute care, care after surgery or a stroke for example, from four different places: "a skilled nursing facility (SNF), a hospital-based inpatient rehabilitation facility (IRF), a long-term care hospital (LTCH), or from a home health agency."
The history, design, and classification rules of the DRG system, as well as its application to patient discharge data and updating procedures, are presented in the CMS DRG Definitions Manual (Also known as the Medicare DRG Definitions Manual and the Grouper Manual). A new version generally appears every October. The 20.0 version appeared in 2002.
APCs or Ambulatory Payment Classifications are the United States government's method of paying for facility outpatient services for the Medicare (United States) program. A part of the Federal Balanced Budget Act of 1997 made the Centers for Medicare and Medicaid Services create a new Medicare "Outpatient Prospective Payment System" (OPPS) for hospital outpatient services -analogous to the ...
Costs for services. Medicare Part A has a hospital deductible—the amount you must pay out-of-pocket before coverage kicks in—and coinsurance (your portion of Part A bills) for hospital and ...
If you have Part B questions, look for answers on Medicare’s site or by calling Medicare (1-800-MEDICARE) or your doctor. Additional reporting by Margie Zable Fishe r. More on Medicare:
The CPT code revisions in 2013 were part of a periodic five-year review of codes. Some psychotherapy codes changed numbers, for example 90806 changed to 90834 for individual psychotherapy of a similar duration. Add-on codes were created for the complexity of communication about procedures.
Though the medical and health services literature has a variety of definitions of readmissions, the Centers for Medicare and Medicaid Services (CMS) has created a stricter set of criteria. CMS defines a hospital readmission as "an admission to an acute care hospital within 30 days of discharge from the same or another acute care hospital. [1 ...
The PPS was established by the Centers for Medicare and Medicaid Services (CMS), as a result of the Social Security Amendments Act of 1983, specifically to address expensive hospital care. Regardless of services provided, payment was of an established fee. The idea was to encourage hospitals to lower their prices for expensive hospital care.