Prospective Payment Implementation Services Overview

PPS Strategy

Payers are leveraging the established framework of Medicare’s Prospective Payment System to decrease the cost of care. This strategy enables payers to “pay as Medicare” pays, which can reduce in-network reimbursement costs by 25 percent.

Implement PPS to Manage:

• Out-of-network managed Medicaid and Medicare Advantage claims
• Commercial business
• Inpatient and outpatient claims

PPS Experience

Our professional services team has the experience you need for your PPS implementation, experience gained by working with the 120 payer organizations that rely on OptumInsight solutions.

Industry Moving Toward PPS

The benefits and opportunities of PPS are becoming increasingly clear to the health care industry and will continue to drive the adaptation of PPS to commercial populations. Both payers and providers alike can benefit from the more appropriate and efficient alignment of risk that PPS brings.