PPS Pricer – An Accessible and Cost-Effective Web-Based Tool

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What is the Prospective Payment System and What is the Purpose of Using a PPS Pricer?

The Prospective Payment System or PPS is a popular method of medical insurance claim reimbursement in which, the payment is made by the insurance company on the basis of a fixed predetermined amount. Different types of medical, surgical, and diagnostic services are classified into separate categories. And so, the amount for a particular healthcare service is determined on the basis of the predetermined cost of that particular category of services to which the healthcare service belongs. For example, diagnosis-related groups, inpatient hospital services, ambulance services, hospice care, and so on.

The PPS is classified into the following categories by The Centers for Medicare & Medicaid Services – Acute Inpatient PPS or Inpatient PPS (IPPS), Federally Qualified Health Centers PPS (FQHC PPS), Home Health PPS (HH PPS), Hospice, Inpatient Rehabilitation Facility PPS (IRF PPS), Inpatient Psychiatric Facility PPS (IPF PPS), Long-Term Care Hospital PPS (LTCH PPS), and Skilled Nursing Facility PPS (SNF PPS).

The PPS payment system is a very beneficial process as in this case, the healthcare providers are unable to charge an exaggerated reimbursement amount and the Medicare patients receive quality healthcare services at low costs. The cost of each and every healthcare service is fixed and hence, there are no scopes of any hidden or inflated charges. This system makes it easier for the payers to reimburse the claimed amount according to the predetermined rates and hence, it proves to be profitable and convenient. It allows Medicare patients to receive cost-effective and top-class healthcare services.

The PPS Pricer is very simple and hassle-free to set up and use. By using the PPS Pricer, the medical claims are repriced and edited and the reimbursement amount is determined by the payers. It is a highly efficient web-based tool that is widely used today as it is a low-cost solution and provides precise results within a few seconds.

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