Medicare Payment Systems MLN Educational Tool Revised

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

Learn about 2022 regulation changes to payment, quality, and policy for:

  • Acute care hospital
  • Hospice
  • Skilled nursing facility
  • Ambulatory surgical center
  • Hospital outpatient
  • Inpatient psychiatric facility
  • Inpatient rehabilitation facility
  • Long-term care hospital
  • Durable medical equipment, prosthetics, orthotics, & supplies (New)
  • Home health

This Medicare Payment Systems educational tool explains how each service type payment system works.

A Prospective Payment System (PPS) refers to several payment formulas when reimbursement depends on predetermined payment regardless of the intensity of services provided. Medicare bases payment on codes using the classification system for that service (such as diagnosis-related groups for hospital inpatient services and ambulatory payment classification for hospital outpatient claims).

This tool explains the inpatient hospitals, hospice, hospital outpatient, inpatient psychiatric facilities, inpatient rehabilitation facilities, long-term care hospitals, ambulatory surgical centers, durable medical equipment, prosthetics, orthotics, and supplies, home health, and skilled nursing facilities payment systems.

You’ll find substantive content updates in dark red font.

Keep scrolling down this website and you’ll find individual payment systems beneath What’s Changed?

For example, here’s the section for the SNF PPS system:

Note that there are several expandable sections beneath each payment system.

In the upper right corner of this landing page, you’ll see

Using that print option, you can print and/or safe this MLN educational tool as a PDF.  It’s 98 pages in length.  You’ll also see the

to the right of each payment system.

This tool was revised/updated as of February 2022.

This is a rich resource, to be sure.  One worthy of bookmarking for future reference.