Essay - Skilled Nursing Prospective Payment System Introduction Prospective Payment System (Pps)...

Skilled Nursing Prospective Payment System

Introduction

Prospective ***** System (PPS) for skilled nursing facilities (SNF) comes under the Medicare recipient provision 4432(a) of the Balanced Budget Act (BBA) of 1997 (HHS.gov, 2009, found online). This was a revision to the Medicare plan, where previously *****re had been no prospective payment system, but a "cost based," or, on the adjustable low volume ***** system (HHS.gov, online), ***** government is *****w utilizing PPS (HHS.gov, online), which has some features that actually mean higher payments to ***** nursing *****. The new payment system was implemented effective July 1, 1998, and initial rates were based on the fiscal year (FY) 1995 cost rep*****ts ***** ***** filed by the skilled nursing facilities (HHS.gov, online).

The PPS ensures that *****re is an adjustment for those facilities that are located in geographically remote *****as (HHS.gov, onl*****e), or areas where utilization can be impacted by the geographic location. F***** many skilled nursing *****, this is an improved payment system over ***** prior one, *****d it gives the skilled nursing facilities an opportunity to receive higher reimbursement rates. The prospective payment system was intended to create an even playing field for skilled nursing ***** regardless of geographical location. This is ***** equitable payment system, but it could mean doing more accounting and reporting for some facilities, and revisions in some billing of services.

This brief essay will examine the prospective payment system in an effort to underst***** the language and the ***** and payment processes, and what those mean to skilled nurs*****g facilities.

Better Reimbursement Rates for Skilled ***** Facilities

***** current prospective payment system came about after much lobbying of Congress by ***** skilled nursing home industry. There was the prevailing thought that ***** nursing *****s were being reimbursed unfairly, because ***** was dependent upon whether or not skilled nursing facilities, or classified as intermediate care facilities (ICFs) (Ubokudom, Sunday, Woods, JA, and Schalk, L*****inda, 2002, p. 321). The skilled nursing facility has always been paid under the Part B component of Medi***** (outpatient, physicians, and special services), but was ***** following Part A reimbursement (inpatient care), when patients were transferred immediately from ***** care, to ***** nursing facilities (HHS.gov, online). It is distinguished from the more permanent setting ***** long term care facilities (LTCFs), because patients are ordinarily discharged from a skilled ***** course of c*****, ***** return home with service through a ***** health care (HHC) component of service.

***** experts feel that ***** move to a prospective payment ***** means ***** just better reimbursement for skilled nursing *****, but also lends itself to an improvement in the quality of care and ***** that are delivered to the patient (Kolb, Patricia, 2003, p. 137). One of the biggest incentives ***** the ***** payment system is that it incorporates an element of the provider's cost in paying professional staff, and thusly, should manifest as more and even higher quality in professional ***** that are employed by ***** facility. The *****s of the prospective payment system are:

1.