Chapter 8 PPS Grid
Complete the following grid by using the information from chapter 8 of your textbook. Enter N/A or none if the concept does not apply to the
payment system.
Payment System
Medicare Physician and Other Health Professional Payment System
Reimbursement methodology
The reimbursement methodology for this payment system is fee schedule. The MPFS is not a
prospective payment system. A physician can increase reimbursements by increasing the volume of
individual service provided to a patient.
Classification or resource
weighting system
The payment is divided into two parts: the resource-based relative value scale (RBRVS) and the
Medicare physician fee schedule (MPFS). Centers for Medicare and Medicaid services uses the
RBRVS, a resource measure system that assigns values to services performed by physicians and other
health professionals based on the cost of furnishing service in different settings, the skill and training
levels required to perform the services and the time and risk.
Packaging concepts
N/A
Severity of illness component
N/A
Low-income patient provision
Alternative Payment Model (APM) is a payment approach that provides incentives for the provider to
deliver high-quality and cost-efficient care.
Rural facility adjustment
N/A
Outlier provision
N/A
Other provisions and adjustments
A geographic is necessary because costs vary in different areas of the country.
Adjustment for wages
N/A
Adjustment for cost-of-living
Quality Payment Program (QPP) is a payment incentive program for physicians and eligible clinicians
that links physician payment to quality measures and cost saving goals.
