Enrollment and Payment System (EPS) (Health Care) Law and Legal Definition
Enrollment and payment system (EPS) refers to all the activities adopted by a partner company for developing and administering various aspects such as enrollment, payments, and appeals under the retiree drug subsidy program (RDS). It refers to the process of providing ex servicemen access to VA health care benefits offered by the medical benefits package.
Enrollment in health care refers to the process of applying for and obtaining medicare coverage. Medicare coverage involves namely two parts: part A and part B. Part A enrollment is automatic for persons who file social security retirement benefits or railroad retirement. Part B enrollment is also automatic unless persons ‘opt-out.’ Enrollment in part A and part B for persons above 65 and not covered by social security is voluntary and upon their free will. Those medicare beneficiaries who do not enroll within the deadline prescribed need to pay a late-enrollment penalty (LEP). A person above 65, working, covered by an employee health plan and enrolled in Part A, can postpone enrollment without penalty. They will get a special enrollment period of seven months post retirement.
Medicare uses a prospective payment system for institutional care such as hospital and nursing home care. In a prospective payment system, the health care institution is reimbursed according to set fee schedules based on the diagnosis, instead of the actual amount of care provided. Large health care facilities that serve many people adopt the capitated payment system.
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