It includes a system for paying hospitals based on predetermined prices, from Medicare.
Payments are typically based on codes provided on the insurance claim such as these:[1] The PPS was established by the Centers for Medicare and Medicaid Services (CMS), as a result of the Social Security Amendments Act of 1983, specifically to address expensive hospital care.
The per-visit rate for the Medicaid PPS is specific to the individual health center location.
The rate is determined and updated by a financial accounting process conducted by State Medicaid agencies.
[3] [4] Aside from FQHCs, other entities that provide outpatient services to Medicaid patients, that are also paid by a PPS methodology include: