Question

Two patients have the same insurance plan and the same DRG. Patient Jone's inpatient stay lasted 1 day. Patient Smith's inpatient stay lasted 2.5 days. How much more will the PPS pat for Smith's claim?

Answer 1

The PPS pays hospitals based on a predetermined amount for each DRG, regardless of individual length of stay. So, the PPS will not pay more for Patient Smith's claim compared to Patient Jones' claim.

Step-by-step explanation:

The PPS (Prospective Payment System) pays hospitals based on a predetermined amount for each diagnosis-related group (DRG). In this case, both Patient Jones and Patient Smith have the same insurance plan and DRG. The payment is calculated based on the average length of stay for the specific DRG, not on the individual length of stay.

Therefore, the PPS will pay the same amount for both Patient Jones and Patient Smith, regardless of the difference in their lengths of stay. The calculations do not take into account the individual differences in length of stay, but rather an average value.

So, the PPS will not pay more for Patient Smith's claim compared to Patient Jones' claim because they have the same insurance plan and DRG.