Medicare Payment System Provisions

Medicare Payment System Provisions (Level 4—Analyzing)
Prospective payment system rates are based on national “average” cost figures. Taking the national average
cost into consideration, CMS sets base rates for each payment system. The payment systems then add
provisions or adjustments to the system to account for situations where the cost of an individual encounter or
service may be higher or lower than the national average.
Pick three provisions from the Medicare Hospital Outpatient Payment System discussed in chapter 7.
Discuss why each provision is needed.
What would happen if the provision were discontinued?
How would this impact facilities or providers?
How would this impact the Medicare beneficiary?
Remember to use a source (even if it’s the textbook) engage with your classmates by responding to another’s
post at least once. This week you will need to post your initial response (by Wed) before seeing others.
Using Threaded Discussions
If you’re the first to enter the Discussion, there will only be a Reply bar below the topic. Otherwise, you will see
others’ posts below. Click on the wide “Reply” bar just below the topic to respond to the topic. Click on the
smaller “Reply” buttons at the bottom left of other responses to reply to someone else’s response

Sample Solution