Conclusion

The Medicare Prospective Payment System has created opportunities for registered nurses and advanced practice nurses to change practice for the benefit of residents and the professions. The PPS system was designed to be self-balancing with care, quality, and payment based on the same tool. In some settings, there may be pressure to "enhance" assessment to qualify for payment above that actually due for the resident. Any such pressure must be rejected. Nurses must understand the process of both resident assessment and prospective payment to insure appropriate care, appropriate payment, and to avoid potential pitfalls. Registered nurses are the critical element in successful implementation of the Prospective Payment System. Nurses must be prepared for the challenge.