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 standards, healthcare payment systems should employ distinct PPSs to adjust for 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 use the PPS to generate fair and defensible reimbursement rates for the use of PPS methodology in Medicaid payment schemes and Medicare Advantage. Health insurance firms share risk with their provider network by utilizing Medicare's Prospective Payment Systems (PPS). This holds each group accountable for the portion of risk that they can effectively control. Create customized healthcare payment systems that can assess PPS rates on a national or regional scale, rely on correct data in contract negotiations, and provide a variety of state-specific rate files. Our healthcare payment solutions help to reduce risk by effectively sharing and managing the risk associated with health care utilization.