Introduction:

The Prospective Payment System of CMS consists of thirteen schedules that allow the calculation of payment for a patient encounter. The DRG or price-based system covers inpatient charges from one of these schedules.

Tasks:

• Describe the schedules of CMS.
• Provide an example of a charge for each schedule.
• Describe the case mix concept that alters payment rates.
• Describe the diagnosis related group payment system.