What is the prospective payment system used for Medicare hospital outpatients?

Prepare for the RHIA Reimbursement Test with multiple choice questions, each accompanied by hints and explanations. Ace your exam with confidence!

The correct answer is based on the fact that the Ambulatory Payment Classification (APCs) system is specifically designed for Medicare hospital outpatient services. Under this system, outpatient claims are categorized into groups that reflect the level of services provided to patients, determining payment rates that are more predictable and consistent. This classification allows for the reimbursement of various outpatient procedures and services based on these defined groups, streamlining the billing process and offering a clear framework for hospitals to receive payment for the outpatient care they provide.

The other choices are related to different payment systems; for example, RBRVS (Resource-Based Relative Value Scale) pertains primarily to physician services rather than hospital outpatient settings, while MS-DRGs (Medicare Severity Diagnosis Related Groups) are used for inpatient hospital services. APGs (Ambulatory Patient Groups) are a system that focuses more on services in certain non-hospital outpatient settings, but they do not encompass the broader aspect of Medicare hospital outpatient reimbursement, which is what the question specifically inquires about.

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