What does PPS stand for in home health payment?

• A. Patient Payment Schedule
• B. Primary Patient Service
• C. Post-Provider Settlement
• D. Prospective Payment System

Answer: (D)

Prospective Payment System means Medicare assigns a fixed payment amount for a 60-day home health episode at the start of the period, based on the patient’s clinical characteristics and other factors, rather than paying the actual costs incurred. This rate is determined by Home Health Resource Groups and includes case-mix and wage-index adjustments to standardize payments across providers. In short, payment is planned in advance and not tied to the exact services or costs after care. The other terms don’t reflect this Medicare reimbursement approach.