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Prospective Payment Systems (PPS)

A Medicare payment plan including pre-determined payment rates based on a patient's diagnosis or level of resource utilization. All Medicare providers are reimbursed under this plan through either a scheduled fee or prospective payment system.

Usual, Customary or Reasonable (UCR)

An industry term for the typical rates charged for services in a specific region. For example, if a surgeon in Virginia were to charge twice…