Introduction: CMS Reimbursement And Essential CMS-1500 Instructions

The Prospective Payment System of CMS consists of thirteen schedules that allow the calculation of payment for a patient encounter. The DRG or price-based system covers inpatient charges from one of these schedules.


  • Describe the schedules of CMS.
  • Provide an example of a charge for each schedule.
  • Describe the case mix concept that alters payment rates.
  • Describe the diagnosis related group payment system.