Introduction to Healthcare Payment System

A healthcare payment system is a software solution that digitalizes the entire payment lifecycle in the healthcare industry, either partially or fully. Because there are multiple ways to repay providers, software solutions for each go a long way toward expediting healthcare reimbursement processes between patients, providers, and payers. Platforms for healthcare payment processing reduce provider operational costs, reduce the possibility of errors through automation, and promote accountability across the payment workflow.    

How Prospective Payment System Work?

Prospective Payment Systems (PPS) are reimbursement mechanisms that base Medicare payments on a predetermined, fixed amount in healthcare payment systems. The healthcare payment amount for selected services is determined by the service classification system. For example, inpatient hospital services may be divided into diagnosis-related groups. According to CMS guidelines, healthcare payment systems should use separate PPSs to compensate different billing. There are many PPS systems used in healthcare payment models for home health agencies, acute inpatient hospitals, hospice, inpatient psychiatric facilities, hospital outpatient, long-term care hospitals, inpatient rehabilitation facilities, and skilled nursing facilities. 

Customize cutting-edge healthcare payment systems that employ the PPS approach to establish fair and defensible reimbursement rates for Medicaid and Medicare Advantage programs. Health insurance companies share risk with their provider network by utilizing Medicare's Prospective Payment Systems (PPS). This keeps each organization accountable for the amount of risk that they can effectively manage. Create customized healthcare payment systems that can assess PPS rates on a national or regional scale, use accurate data in contract negotiations, and provide a variety of state-specific rate files. Our healthcare payment solutions contribute to risk reduction by effectively sharing and managing the risks associated with healthcare utilization.