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Which prospective payment system (pps) determines a preestablished payment that depends on the patient's principal diagnosis, comorbidities, complications, and principal and secondary procedures?

a. mpfs
b. opps
c. snf pps
d. ipps

1 Answer

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Final answer:

The correct answer is d. IPPS, which stands for Inpatient Prospective Payment System, a system that sets preestablished payments for hospital care based on diagnosis-related groups accounting for various factors related to the patient's health condition.

Step-by-step explanation:

The prospective payment system that determines a preestablished payment based on the patient's principal diagnosis, comorbidities, complications, and principal and secondary procedures is d. IPPS, which stands for Inpatient Prospective Payment System. This system contrasts with others such as the Medicare Physician Fee Schedule (MPFS), Outpatient Prospective Payment System (OPPS), and Skilled Nursing Facility Prospective Payment System (SNF PPS), each designed for different settings and payment structures.

The IPPS aims to motivate hospitals to provide cost-effective care without compromising quality. It also serves as a measure to combat adverse selection by standardizing payments for similar patient cases, thereby mitigating the risk of insurance companies encountering high-risk parties overly benefiting at the expense of low-risk parties avoiding insurance due to high costs.

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