Inpatient Prospective Payment System (IPPS)
Posted Thursday, January 17, 2019Did You Know? Starting January 2019 hospitals are required to digitally publish pricing on the most common procedures
Navigating Transparency in Pricing
The Continuous Changes in Healthcare Creates a Constant Need for Knowledge Sharing and Physician Support
01 | What is IPPS?
The Inpatient Prospective Payment System (IPPS) was implemented in 1983 for Medicare cost management. It was created to standardize payments to hospitals and patient care facilities. Prior to IPPS, Medicare reimbursement to facilities was paid out in the amount the facilities spent or submitted for reimbursement. There was no control on spend or costs and the amounts being paid out could differ wildly between hospitals.
IPPS created a framework for reimbursement, creating a need to control costs while maintaining quality healthcare. While there are benefits and challenges to any law or rule implemented in healthcare it is important to acknowledge the effects of these rulings in the industry.
02 | Benefits
There is more efficiency and less uncertainty with IPPS. A hospital or practice has confidence in knowing what will be approved and for what amount. Private insurers are more inclined to follow reimbursement practices of a nationwide program. Cost savings across organizations occurs due to the stability of the system.
03 | Challenges
Unfortunately, hospitals and physicians tend to be reluctant to take on more complicated and intricate cases out of fear of reimbursement restrictions and patient payment commitment. Offices can find it difficult to get reimbursement or approval for testing and consultation appointments that are deemed “unnecessary” for proper patient care.
04 | Effects on Physicians
Medicare and reimbursement is an ever-changing space which can cause confusion and frustration. New rules are passed and added frequently. It is important that facilities are knowledgeable in these changes and are ready to meet legal requirements by deadlines; in order to prevent any adverse events. Offices must have the proper knowledge, training, and implementation procedures and processes in place in order to properly adhere to any IPPS rules.
Having access to services and teams who are well versed in any IPPS rules is beneficial to any organization. Maintain full awareness by encouraging and supporting continued education in these areas with seminars, publications, and classes.
Learn More
Contact us today to learn more about the resources available to Matrix GPO members, as well as new and exciting services available to the healthcare industry. Click here to visit the Matrix GPO website and fill out an enrollment form.
References
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html
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