New Medicare Summary Notice (MSN) Message for Higher than Expected (PPS) Payments
When Medicare sets payment prospectively, a payment unit is worked out in advance for a whole group of services that are delivered together as part of a single Medicare benefit. This type of payment is made instead of paying each service alone on the basis of its individual cost. Consequently, sometimes payments may be less than expected based on charges for individual services, but also, sometimes greater than expected. Prospective payment gives health care providers an overall incentive to be efficient in delivering care, and keeps Medicare payment largely within previously set prospective rates. Consequently, this Change request (CR) proposes a new MSN message to briefly explain the higherthan-expected amounts outlines above.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: April 28, 2010
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