How Does Hcpt, and Icd, and Cms Codes Differ.

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What payment methodologies does the CMS use? The center for Medicare and Medicaid Services use the prospective payment system (PPS). The PPS system is a method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount. The payment amount for a particular service is derived based on the classification system of that service (for example, diagnosis-related groups for inpatient hospital services). CMS uses separate PPSs for reimbursement to acute inpatient hospitals, home health agencies, hospice, hospital outpatient, inpatient psychiatric facilities, inpatient rehabilitation facilities, long-term care hospitals, and skilled nursing facilities. (CMS.gov, 2013) The CMS requires Medicaid programs to make payments for FQHC/RHC services in an amount calculated on a per-visit basis that is equal to the reasonable cost of such services documented for a baseline period, with certain adjustments, or to use an alternative payment methodology to pay for FQHC and RHC services. CMS.GOV, Nov. 2013,http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ProspMedicareFeeSvcPmtGen/index.html How do CPT, ICD, and HCPCS codes differ? International Classification of Diseases (ICD-9) coding is a statistical classification system that arranges diseases and injuries into groups according to established criteria, by the world health Organization. Majority of ICD-9 codes are numeric and consist of three, four or five numbers and a description. Example: An ICD-9 code for a broken ankle is fractured ankle, 824.8. In addition, injuries are also coded according to their location on the body. So, the code for the broken ankle would indicate whether it was the left, right or bilateral (both) ankles. In addition, an injury site may be listed if necessary. CPT (Current Procedural Terminology) codes are numbers assigned the services rendered by medical

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