Hospital Outpatient Prospective Payment System

1 Hospital Outpatient Prospective Payment System 

What should WPS do with CMS to improve the process?

To improve the process, the WPS must work with the CMS to allow reimbursement

remedies of FISS. It will be essential to clarify what will be done by WPS to fix the present issues (Kassing & Berry, 2020). To prevent miscounts from happening in the future, the CMS should consistently have a second count of the gadgets that were used. Furthermore, improving the process may also require the WPS to improve its training process.

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As an executive for the Wisconsin Physicians Service (WPS) Insurance Corporation, write a response letter that addresses the issues after reviewing the case.

The Wisconsin Physicians Service should develop a more extensive plan on how to

ensure that the CMS strengthens the FISS prepayment edits by keeping a close eye on the unit amounts in certain medical devices (Theosmy et al., 2021). Similarly, the OPPS should also better educate their coders to ensure that they can adequately code the devices and units. Lastly, the Board of directors should also come up with a contingency that will ensure that something of this nature does not take place again in the future (Theosmy et al., 2021). 

Include three recommendations, with supporting rationale, of how to improve the processes in your response.

a. The WPS should see to it that it recovers the money lost in overpayment. b. The WPS should ensure the right coding with the right number of clinical gadgets in medical facilities. c. The WPS should also collaborate with the CMS to secure FISS prepayment edits by examining the unit amount caps for certain medical devices.

3 References Kassing, P., & Berry, C.D. (2020). Hospital outpatient prospective payment system: A maturing prospective payment system. Journal of the American College of Radiology, 17(4), 534541.

Theosmy, E., Yayac, M., Krueger, C.A., & Courtney, P.M. (2021). Is the new outpatient prospective payment system classification for outpatient total knee arthroplasty appropriate? The Journal of Arthroplasty, 36(1), 42-46.