Chapter 7 PPS Grid
Complete the following grids by using the information from chapter 7 of your textbook. Enter N/A or none if the concept does not apply to the
payment system. Enter N/A or none if the concept does not apply to the payment system.
Payment System
Medicare Outpatient Hospital Services Payment System
Reimbursement
methodology
Fee schedule, prospective and reasonable cost payments.
Classification or resource
weighting system
Grouped based on procedure and resource consumption.
Packaging concepts
Minor and extensive, encourages hospitals to be cost effective.
Severity of illness
component
N/A
Low-income patient
provision
Packaging concepts helps with the cost of those who are unable to pay.
Rural facility adjustment
7.1 per cent increase for sole community hospitals.
Outlier provision
High-cost outlier services based on the cost of individual services rather than for the entire encounter.
Other provisions and
adjustments
Pass Throughs to help with the costs.
Adjustment for wages
Simple and complex adjustments.
Adjustment for cost-of-
living
Reimbursed and accounts get bigger.
