TechnicalJones.com

Definition:  A payment method that establishes rates, prices or budgets before services are rendered and costs are incurred. Providers retain or absorb at least a portion of the difference between established revenues and actual costs.

(1) The Medicare system used to pay hospitals for inpatient hospital services; based on the Diagnosis Related Groups (DRG) classification system.

(2) Medicare's acute care hospital payment method for inpatient care.

Prospective per-case payment rates are set at a level intended to cover operating costs in an efficient hospital for treating a typical inpatient in a given diagnosis-related group.

Payments for each hospital are adjusted for differences in area wages, teaching activity, care to the poor, and other factors.

Hospitals may also receive additional payments to cover extra costs associated with atypical patients (outliers) in each DRG.

Capital costs, originally excluded from PPS, are being phased into the system. By 2001, capital payments will be made on a fully prospective, per-case basis.