Question

A group of nursing students is preparing a presentation on the major diagnostic categories and diagnosis-related groups. What is the correct name for this system?

1) Prospective Payment System (PPS)
2) Medicaid
3) Medicare
4) Older American Act

Answer 1

The Prospective Payment System (PPS) is the correct name for the system that categorizes hospital cases for Medicare reimbursement. Medicare is for those over 65 or with certain disabilities, while Medicaid is for low-income individuals. The ACA expanded coverage but is distinct from Medicare and Medicaid.

Step-by-step explanation:

The correct name for the system that includes major diagnostic categories and diagnosis-related groups is the Prospective Payment System (PPS). The Prospective Payment System is used by Medicare to reimburse hospitals for inpatient stays, and it classifies each case into a diagnosis-related group (DRG) with fixed reimbursement amounts based on the diagnosis and treatment.

Medicare is a federally funded program that provides health insurance primarily to individuals over the age of sixty-five and to those with certain disabilities. Meanwhile, Medicaid is designed to provide health care services to people with low income. The Patient Protection and Affordable Care Act (ACA or Obamacare) expanded healthcare coverage, but it is separate from the concepts of Medicare and Medicaid.