Click for an example. %Qc\R*i7h]bUNOOV9h>#Vr #IB}gYIK!U(zhrDg K=~)au\}p)=fi+i:inP}&EuJFRR9(G@OgJi]}MK@bA>@d+ "h#.UM=@~t}qZ"=kW ]1~pcP| One in every five Medicare beneficiaries is hospitalized one or more times each year. Each option comes with its own set of benefits and drawbacks. The CCBHC establishes or maintains a health information technology (HIT) system that includes, but is not limited to, electronic health records. Units of payment and payment adjustments may also result in different rates for similar patients depending upon where they are treated. PPS rates are based on total annual allowable CCBHC costs. Senior Manager, Payment Strategy and Innovation, Payer Relations and Contracting, University of Utah Health, Three Challenges for the Next Decade of Health Care, Is Less More? lock This file is primarily intended to map Zip Codes to CMS carriers and localities. Official websites use .govA endstream endobj 2460 0 obj <>stream Section 10501 of the Patient Protection and Affordable Care Act of 2010 modified how payment is made for Medicare services furnished at Federally qualified health centers (FQHCs). Find the right brokerage account for you. A bundle. If a state chooses to provide CCBHC services via telehealth, costs related to those services should be included in the PPS. Capitalized HIT systems may otherwise be considered overhead and allocated to CCBHC services through depreciation as part of the PPS rate development process, and therefore, are included in the PPS rate. Visit SAMHSA on Instagram Inpatient Psychiatric Facility (IPF) PPS classifications are based on a per diem rate with adjustments to reflect statistically significant cost differences. The Motley Fool has a disclosure policy. PPS 4.2.c. There are pros and cons to both approaches, though the majority of bundles fall into the former category (retrospective) for reasons described below. That screening may occur telephonically. This file is primarily intended to map Zip Codes to CMS carriers and localities. Heres how you know. PPS Section 2. 526 0 obj <>/Filter/FlateDecode/ID[<8D14DD9A0426F046932773501A2B6F32>]/Index[506 41]/Info 505 0 R/Length 104/Prev 262205/Root 507 0 R/Size 547/Type/XRef/W[1 3 1]>>stream In the U.S., cost tends to play a role in the way patients receive medical care. Washington, D.C. 20201 Such cases are no longer paid under PPS. U.S. Department of Health & Human Services (b) money owed to the insurer from the health care system if the cost of patient care exceeded the set price for the bundle AND whether there were agreed-upon stipulations for exceeding that threshold*This is often referred to as outlier costs, or in some cases risk corridors.. Aside from potential additional gains or losses, the funds for retrospective payments are paid in the same manner of non-bundled care. The Centers for Medicare & Medicaid Services (CMS) April 27 issued its hospital inpatient prospective payment system (PPS) and long-term care hospital (LTCH) PPS proposed rule for fiscal year (FY) 2022. Download the most recent AHA Inpatient PPS Advisory for a discussion on each of the programs. Payment for ambulatory surgical center (ASC) services is also based on rates set under Medicare Part B. These are timeframes where the total costs for patient care are assessed over several months while the care is still being paid for via the patient, insurance (private or government), employer, or a combination of the three. This is based on the operating and capital-related costs of a medical diagnosis and determines reimbursement for care provided to Medicare and Medicaid participants. To sign up for updates or to access your subscriber preferences, please enter your contact information. On the other hand, retrospective payment plans come with certain drawbacks. This is based on the operating and capital-related costs of a medical diagnosis and determines reimbursement for care provided to Medicare and Medicaid participants. HTn0}WQ E7_8@:iQO4\4d)[v0&ER.*'\^ BdF$Q# w!q".%?cc:2PS\PKJT\^cbm*$VA^bhu02OgohEyd12RBf7EbZU>05-F~h #eGw~F+: j)9i4HrAl^R$YVLJH0;'yV[Odj0na`UUUPg~^uuc&. Sign up to get the latest information about your choice of CMS topics. Why? At a high-level there are two primary funding mechanisms for bundles: (1) retrospective (like all other hospital payments) and (2) prospective payments. hbbd``b` BH0X B"Ab9,F? D> To sign up for updates or to access your subscriber preferences, please enter your contact information below. From a financial standpoint retrospective payments for bundles are easier to understand, administer, and execute, which is why they comprise the majority of bundled payment financing arrangements. Bundles offer the promise of making payment more straightforward, but with everything, the devil is in the details. website belongs to an official government organization in the United States. Cumulative Growth of a $10,000 Investment in Stock Advisor, Join Over Half a 1 Million Premium Members And Get More In-Depth Stock Guidance and Research, Copyright, Trademark and Patent Information. Some fear that providers might try to abuse the carte blanche nature of these plans by recommending treatments or services that are more complicated and costly than necessary in order to maximize profits. Everything from an aspirin to an artificial hip is included in the package price to the hospital. 2456 0 obj <> endobj Further, no new RO episodes may start after Oct. 3, 2026, for all RO episodes to end by Dec. 31, 2026. Founded in 1993 by brothers Tom and David Gardner, The Motley Fool helps millions of people attain financial freedom through our website, podcasts, books, newspaper column, radio show, and premium investing services. Access the below OPPS related information from this page. 0 @= With the prospective payment system, or PPS, the provider of health care, such as a hospital, receives one fixed payment for a particular type of care over a particular period of time. States may claim federal matching funds for translation or interpretation service costs either as an administrative expense or as a medical assistance-related expense. This could result in replacing the four independent PPSs for skilled nursing facilities, home health agencies, inpatient rehabilitation facilities and long-term care hospitals with one for post-acute care. Because providers receive the same payment regardless of quality of care, some might be moved to offer less thorough and less personalized service. ItB}b% `>;=*n vL>Tim PPS 4.2.b. The success or failure of prospective payment will be determined by its ability to effect a suitable change in the behavior of those who manage the Nation's hospitals. Sound familiar? Additional payment (outlier) made only if length of stay far exceeds the norm, Patient Assessment Instrument (PAI) determines assignment of patient to one of 95 Case-Mix Groups (CMGs). (3) Care providers benefit from knowing the predictable amount they will get paid for patient care, even if the costs associated with that care are less than the agreed-upon bundle amount. Section 223 (a)(2)(B) requires that CCBHCs not reject or limit services based on a participants ability to pay but does not authorize Medicaid expenditures for services furnished to individuals who are not eligible for Medicaid. if the costs for a patient surpass a certain threshold (described above). Please visit the FQHC Center page for more information on understanding the methodology and payment rates for the new FQHC PPS. .gov This use to be the most common practice for how providers, hospitals or an organization billed for their services they completed on the patient. hbbd```b``6;@$Uz,&kV0L> gATT?"Hr xlB>?Sl/# X Hospital-Acquired Condition Reduction Program Calculator, Value-Based Purchasing Program Calculator, Webinar: FY 2022 Inpatient Prospective Payment System (IPPS) Proposed Rule May 24, 2021. 1.c.1. PPS 2.1. We asked Zac Watne, Utahs payment innovation manager (he gets paid to understand the volatile world of payment reform) to give us a primer on bundles. Regardless of change happening in healthcare, thought leaders predict that payment reform, and specifically bundled payments, are here to stay. The IPPS pays a flat rate based on the average charges across all hospitals for a specific diagnosis, regardless of whether that particular patient costs more or less. As mentioned before, most of the financing to health care systems/doctors comes AFTER care has been delivered. 2469 0 obj <>/Filter/FlateDecode/ID[<42D2C4C5FE2C444AACE59A6F4DA8EF4D><669E471A3E7D0D40BC31A22171146911>]/Index[2456 18]/Info 2455 0 R/Length 71/Prev 308645/Root 2457 0 R/Size 2474/Type/XRef/W[1 2 1]>>stream The primary benefit of retrospective payment plans is that they may allow patients to receive more attentive. In addition to finalizing a 2.5% increase in inpatient PPS payments for Medicare & Medicaid Services (CMS) Aug. 2 issued its hospital inpatient prospective payment system (PPS) and long-term care hospital (LTCH) PPS final rule for fiscal year (FY) 2022. Non-Prospective Payments, also called Retrospective payments, is a reimbursement method that pays providers on actual charges (Prospective Payment Plan vs. Retrospective Payment Plan, 2016). Program Requirements 1.A and 1.B: Staffing needs. Categories or groups are set up around the expected relative cost of treatment for patients in that category or group, and are . Once you meet the deductible, Medicare pays most of the total payment and . ( The payment amount for a particular service is derived based on the ification system of that service (for example, diagnosis-related groups for inpatient hospital services). The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. The rationale for contracting for a bundle is threefold: (1) Patients benefit from having a team of providers focused on improving care processes, which often result in reduced procedures, supplies, and transition time. On May 20, 2015, the Centers for Medicare and Medicaid Services (CMS) issued guidance to states and clinics on the development of a PPS to be tested under the Section 223 Demonstration Program for CCBHCs, as required in Section 223 of the Protecting Access to Medicare Act (PAMA) (PL 113-93). HSn0+H(;0>) If the costs of care are below the fixed amount, then the system keeps the savings. The CCBHC provides outpatient clinical services during times that ensure accessibility and meet the needs of the consumer population to be served, including some nights and weekend hours. means youve safely connected to the .gov website. To continue the shift from fee-for-service care, healthcare providers are striving to. Prospective Payment Systems (PPS) was established by the Centers for Medicare and Medicaid Services (CMS). Retrospective payments are the norm for bundles, largely because retrospective payment is standard in the health care industry. Payment is complicated, and if you turn on the news or have received health care yourself, youve probably wondered if anything could be done to make it more straightforwardwell, there are efforts underway to make it easier, but the short answer is: its hard. endstream endobj 2457 0 obj <>/Metadata 140 0 R/PageLayout/OneColumn/Pages 2442 0 R/StructTreeRoot 166 0 R/Type/Catalog>> endobj 2458 0 obj <>/Font<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 2459 0 obj <>stream Prospective Payment Systems (PPS) was established by the Centers for Medicare and Medicaid Services (CMS). :aX,Lhu|UQQV ,@00tt0wtp0)* @Q#\!W`E-m 30@bg`(e9> D m Thanks -- and Fool on! 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Federally Qualified Health Centers (FQHC) Center, Healthcare Cost Report Information System (HCRIS) Dataset. Under the IPPS, each case is categorized into a diagnosis-related group to determine the base rate. Compared to fee-for-service plans, which reward the provider for the volume of care provided and can create an incentive for unnecessary treatment, the PPS payment is based on multiple factors including service location and patient diagnosis. A patient who remains an inpatient can exhaust the Part A benefit and become a Part B case. 5600 Fishers Lane, Rockville, MD 20857 There is a potential for add-on payment adjustments for PPS classifications. PPS includes the cost of the scope of services covered by the demonstration, including designated collaborating organization (DCO) costs. Learn More. Sign up to get the latest information about your choice of CMS topics. The CAA provision supersedes the delayed start date established in the CY 2021 OPPS/ASC final rule. PPS 4.2.b. Hear our experts take on stocks, the market, and how to invest. The Chief Executive Officer of the CCBHC maintains a fully staffed management team as appropriate for the size and needs of the clinic as determined by the current needs assessment and staffing plan. Before sharing sensitive information, make sure youre on a federal government site. 2.a.5. ) =n,)$yiD=0:_t #2~{^Y$pCv7cRH*^Aw s`XhcU'Jdv o{^]E,"2[[=Ay. There are only a few changes to make in the HMO model to describe the Medicare PPS systems for hospitals, skilled nursing facilities, and home health agencies. Sometimes the most impactful change comes from simply asking, Why are we doing things this way? Pediatric infectious disease professor Adam Hersh explains the impact of practice inertia on antibiotic treatment in pediatric patients, and how questioning the status quo improved outcomes and reduced cost. PPS 4.1.c. Everything from an aspirin to an artificial hip is included in the package price to the hospital. An official website of the United States government Additionally, prospective payment plans tend to motivate providers to deliver the most efficient care possible. https:// Visit the SAMHSA YouTube channel, Visit SAMHSA on LinkedIn C. u=*{ x3H:Hw\67""gDQybj>&/XCafV)K'>. Bundles deliver care with improved outcomes at a lower price all over the United States. States may claim federal matching funds for translation or interpretation service costs either as an administrative expense or as a medical assistance-related expense. on the guidance repository, except to establish historical facts. Per diem rate for each of four levels of care: Geographic wage adjustments determine the only variation in payment rates within each level. Please enable it in order to use the full functionality of our website. Prospective payment plans also come with drawbacks. This patient classification method indicates groups of patients that would incur similar resource consumption, length of stay, and the costs generally incurred with this diagnosis to classify inpatient groups for payment. !eGPI`^_2LCp fIWA[7J{8 Sf!g He challenges us to think beyond metrics to what patients actually need from us: patient-centered, outcome-focused, affordable care. Calculated by Time-Weighted Return since 2002. Secure .gov websites use HTTPSA All new consumers requesting or being referred for behavioral health services will, at the time of first contact, receive a preliminary screening and risk assessment to determine acuity of needs. Discharge assessment incorporates comorbidities, PAI includes comprehension, expression, and swallowing, Each beneficiary assigned a per diem payment based on Minimum Data Set (MDS) comprehensive assessment, A specified minimum number of minutes per week is established for each rehabilitation RUG based on MDS score and rehabilitation team estimates, The Outcome & Assessment Information Set (OASIS) determines the HHRG and is completed for each 60-period, A predetermined base payment for each 60-day episode of care is adjusted according to patient's HHRG, Payment is adjusted if patient's condition significantly changes. Volatility profiles based on trailing-three-year calculations of the standard deviation of service investment returns. Costs associated with care coordination are in direct expenses during the PPS rate development process, and therefore, are included in the PPS rate. A Prospective Payment System (PPS) is a method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount. Prospective Payment Systems (PPS) was established by the Centers for Medicare and Medicaid Services (CMS). The enables healthcare providers to be aware of the predetermined reimbursement amount for patient care regardless of the amount of care provided. !U}00&nF4t\=Ed L8p!;0L(zkR|g'd8rx\ CeLlLW]ZEWyo H5e 5225t%LlIPxV0nAPDL*mA?+Cg!Cr=54M8L ; Vn_y`U/c*=&uta~>$Y\|d/:6@@1d q|\DH0+bgjAu2jyR"L Certified Clinic PPS (CC PPS-1), and PPS 2.2. Among other changes, the rule finalizes the following. The future may bring. The HMO receives a flat dollar amount (i.e., monthly premiums) and is responsible for providing whatever services are needed by the patient. One caveat: As mentioned before, most of the financing to health care systems/doctors comes AFTER care has been delivered. Access the PPS guidance to states and clinics 2016 (PDF | 789 KB). Federal government websites often end in .gov or .mil. hb```6~1JI In contrast, conventional fee-for-service payment systems may create an incentive to add unnecessary treatment sessions for which the need can be easily justified in the medical record. based on the patients clinical needs. A bundle places all of the care for a certain procedure, or series of procedures, into a single bucket. The Hospital Outpatient Prospective Payment System (HOPPS) is used by CMS to reimburse for hospital outpatient services. 2023 by the American Hospital Association. x9k. Prospective bundles pay a fixed price for services that are covered in the bundle*Coverage can include any or the following: pre-operative care, hospital inpatient stay only, post-acute care, and increasingly warrantees on outcomes. A PPS is a method of reimbursement in which Medicare makes payments based on a predetermined, fixed amount. Prospective payment systems are intended to motivate providers to deliver patient care effectively, efficiently and without over utilization of services. Currently, PPS is based upon the site of care. Prepayment amounts cover defined periods (per diem, per stay, or 60-day episodes). When talking about bundles with both internal and external colleagues some of the first questions are what bundles do we participate in? and how can we establish, or build, a bundle?, This post will address when do I get paid?. ?O-7m hl:'a)B@pTV;/)aJ1_337 % c!AyM$+$N6`T%!li@NQaHB9X{X8ipw+A&C]>C2Z7SLJ#!F]k6Pk-mb0 )jgl[Y OT*>#2jct3m9Wl-ji:fNF1*q3(%yCcb&D5m$@ ywD}k/7Pn wJF;&3puO|kbG~-HZ8aLY*VOk{A^mPdmDr The payment amount is based on a unique assessment classification of each patient. Invest better with The Motley Fool. The PPS for LTCHs is a per discharge system with a DRG patient classification system. The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 228,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students. or To meet those needs health care must shiftfrom organizing around a patients biology to understanding the patients biography. When Medicare was established in 1965, Congress adopted the private health insurance sector's "retrospective cost-based reimbursement" system to pay for hospital services. This file will also map Zip Codes to their State. (Granted the comparison only goes so far, humans are not cars). In developing the rates, states may include estimated costs related to services or items not incurred during the planning phase but projected to be incurred during the demonstration. Prospective payment plansProspective payment plans work by assigning a fixed payment rate to specific treatments. SAMHSA Blog. refers to a fixed healthcare payment system. A Prospective Payment System (PPS) is a method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount. Maybe not for your car, but this is the world patients enter when they receive care. There are two primary types of payment plans in our healthcare system: prospective and retrospective. A federal government website managed by the CMG determines payment rate per stay, Rehabilitation Impairment Categories (RICs) are based on diagnosis; CMGs are based on RIC, patient's motor and cognition scores and age. PPS rates are based on total annual allowable CCBHC costs. Youre reading a free article with opinions that may differ from The Motley Fools Premium Investing Services. PPS determines payment based on a classification of service. 3.b.1. Probably in a month or two, maybe longer. She is the owner of CharmedType.com and MaureenBonatch.com. PPS classification is based on Case Mix Group (CMG) which reflects clinical characteristics and expected resource needs. Discounted offers are only available to new members. At Issue endstream endobj 511 0 obj <>stream Contact USA.gov. (Part B payments for evaluation and treatment visits are determined by the, Primary diagnosis determines assignment to one of 535 DRGs. Hospitals may be eligible for an add-on payment if they are considered a disproportionate share hospital (DSH), in that they care for a large percentage of low-income patients, or if they are an approved teaching hospital for indirect medical education (IME). PPS continues to focus on many of the principles of value-based care. LTCH) is a hospital whose average inpatient length of stay is greater than 25 days. The latest Updates and Resources on Novel Coronavirus (COVID-19). \>Kwq70"jJ %(C6q(1x:6pc;-hx,h>:noXXIVOh1|7; ZB/[5JjpVJ7HGkilnFn@u{ [XZ{-=EAC]v+zlY^7){_1sUK35qnEJ|T{=Oamy72r}t+5#^;.UNm1.Q ~gC?]+}Gf[A \0 A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Bljk_b#rmXGELL4cP IaEM-el,[)d1+k:A9TD Dg!V Click for an example. website belongs to an official government organization in the United States. Prospective payment plans also have the potential to save insurance companies money, and when that happens, some of those savings may be passed on to patients in the form of lower annual premiums and copayments. Share sensitive information only on official, secure websites. PPS 4.2.c. January 11, 2017 - When implementing healthcare bundled payment models, providers and payers have two main strategies to choose from: prospective or retrospective bundles. (2) Payers benefit from having a predetermined price they will pay for care, meaning they know the exact amount they will pay for an episode of care. For a one-stop resource web page focused on the informational needs and interests of Medicare Fee-for-Service (FFS) providers, including physicians, other practitioners and suppliers, go to the Provider Center (see under "Related Links" below). In short, patients vary MUCH more than cars (or anything else we purchase), which is why the health care payment system is dissimilar from most every other service or commodity we buy. Official websites use .govA The site is secure. These are timeframes where the total costs for patient care are assessed over several months while the care is still being paid for via the patient, insurance (private or government), employer, or a combination of the three. Prospective payment systems are intended to motivate providers to deliver patient care effectively, efficiently and without over utilization of services.The concept has its roots in the 1960s with the birth of health maintenance organizations (HMOs). o>nk3c$)%"Ntxt2oJ^vQ/g_!kt5/y^Ztr;,$9/3c];nd.!J6Pd #vQ Y"s For example, for inpatient hospital services, CMS uses separate PPSs for reimbursement related to diagnosis-related groups (DRGs). Successful investing in just a few steps. To the extent possible within the state Medicaid program and as allowed by state law, CCBHCs utilize mobile in-home, telehealth/telemedicine, and on-line treatment services to ensure consumers have access to all required services. HlT]o0|i-h C#qVcnQq$[_Is.s\CY`A SAd_6C1ABIu&13%dv L)X?ic#cG"W%p[pb! Payment also is adjusted for differences in area wage costs -- and depending on the hospital and case -- teaching status, high percentage of low-income patients, the use of new technology and extremely costly cases. The enables healthcare . .gov Use this table as a quick reference to compare the CCBHC criteria 2015 (PDF | 755 KB) and corresponding section of the PPS guidance. The CMS created HOPPS to reduce beneficiary copayments in response to rapidly growing Medicare expenditures for outpatient services and large copayments being made by Medicare beneficiaries. All rights reserved. 1997- American Speech-Language-Hearing Association. Read on to explore resources and other educational tools to learn more about the IPPS. The majority of bundles have "reconciliation periods" (click here to read prior article). PPS refers to a fixed healthcare payment system. American Speech-Language-Hearing Association, Interprofessional Education / Interprofessional Practice, Inpatient rehabilitation hospital or distinct unit, Resource Utilization Groups, Third Version (RUG-III), Each day of care is classified into one of four levels of care. CMS estimates that total payments to hospitals (including beneficiary cost-sharing) will increase by approximately $3.0 billion in CY 2023 compared to CY 2022. Also, when you get your bills, youll have to call the car insurance company if you have questions instead of calling the mechanic directly. Prospective payment thus provides a potential solution to the problem of increasing hospital expenditures that threatens the solvency of the Medicare program. Market beating stocks from our award-winning service, Investment news and high-quality insights delivered straight to your inbox, You can do it. The DRG payment rate is adjusted based on age, sex, secondary diagnosis and major procedures performed. Prospective payment. This is often referred to as outlier costs, or in some cases risk corridors. |)IqwZ*3-|,9$Rr%_^ We Fools may not all hold the same opinions, but we all believe that considering a diverse range of insights makes us better investors. The CCBHC has a training plan. Services of a DCO are distinct from referred services in that the CCBHC is not financially responsible for referred services. Become a Motley Fool member today to get instant access to our top analyst recommendations, in-depth research, investing resources, and more. Market-beating stocks from our award-winning analyst team. endstream endobj 507 0 obj <>/Metadata 30 0 R/Pages 504 0 R/StructTreeRoot 58 0 R/Type/Catalog/ViewerPreferences<>>> endobj 508 0 obj <>/MediaBox[0 0 612 792]/Parent 504 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 509 0 obj <>stream Each option comes with its own set of benefits and drawbacks. PPS continues to focus on many of the principles of, . No payment shall be made to satellite facilities of [CCBHCs] if such facilities are established after [April 1, 2014]. You can decide how often to receive updates. Overhead administrative expenses include costs of running the business such as legal, accounting, telephone, depreciation on office equipment, and general office supplies. Prospective Payment Systems. This is based on the operating and capital-related costs of a medical diagnosis and determines reimbursement for care provided to Medicare and Medicaid participants. PPS 2.2.b describes quality bonus payments under the CC-PPS 2 rate methodology. Secure .gov websites use HTTPSA Switch to Chrome, Edge, Firefox or Safari. Non-Member: 800-638-8255, Site Help | AZ Topic Index | Privacy Statement | Terms of Use In addition to finalizing a 2.5% increase in inpatient PPS payments for 2022 and other policies, t At a Glance The payment amount is based on a classification system designed for each setting. It includes a system for paying hospitals based on predetermined prices, from Medicare. The model performance period will begin on Jan. 1, 2022, and end on Dec. 31, 2026. Prospective Payment Systems - General Information, Guidance for the Prospective Payment System (PPS) method, Issued by: Centers for Medicare & Medicaid Services (CMS). In addition, this file contains an urban, rural or a low density (qualified) area Zip Code indicator. Prospective payment plans have a number of benefits. A state may elect to count this as a visit when the service is delivered by a qualified practitioner. 546 0 obj <>stream Strategic insights, perspectives and industry trends for healthcare executives.
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what is a non prospective payment system 2023