This lesson provides information on covered outpatient Medicare Part B services. It explores the different Part B payment systems, including the Ambulatory Payment Classification system, the Medicare physician fee schedule, and the composite payment rate system (CPRS).
“This program has been approved for 0.5000 continuing education unit(s) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.”
This activity is approved for 0.5000 contact hours.
Section 1: Introduction
About This Course
Section 2: OPPS Basics
Section 3: APCs
OPPS and APCs
Clinical Example of APC-Covered Services
APC-Paid Laboratory Studies
Section 4: Excluded and Ancillary Services
Other Outpatient Payment Methods: Physician Payment
Payment for Therapy
Fee Schedule for Laboratory Studies
Exclusions from Coverage
Section 5: Other Services
End-Stage Renal Disease and Outpatient Maintenance Dialysis
Payment for Ambulance Services
Section 6: Conclusion
Expert Reviewer: Jean C. Russell, MS, RHIT
Richard has more than eighteen years in healthcare consulting. He has developed an expertise in hospital outpatient and inpatient coding, including professional split billing and E/M coding, admission criteria, reimbursement and compliance, and charge master reviews. His areas of expertise include Medicare reimbursement for the Medicare Outpatient Prospective Payment System (OPPS), Medicaid Ambulatory Payment Groups (APGs), as well as commercial payers, and professional reimbursement. He is a certified coder with AHIMA (CCS). Richard earned his Bachelors from Hobart College.Disclosure: Richard R. Cooley, BA, CCS has no Relevant Financial or Non-Financial Relationship with ineligible companies to disclose.
Instructor: Alison Kazmierczak
Jean Russell has over thirty years of healthcare and information system experience. Her areas of expertise include the Medicare outpatient prospective payment systems (APCs, and APGs), as well as ICD-10-CM/PCS training, Charge Description Master (CDM), admission status reviews, and outpatient coding and compliance. She is a frequent speaker at the national, state and local levels for HFMA and AHIMA professional groups. Jean has her Masters from the University of Houston in Biomedical Engineering; her Bachelors from Colgate University in Biology; and her RHIT from the independent study program through the American Health Information Management Association.Disclosure: Jean C. Russell, MS, RHIT has no Relevant Financial or Non-Financial Relationship with ineligible companies to disclose.
Alison has twenty-nine years of healthcare and information system experience, eleven of those years consulting at hospitals across the United States. Her areas of expertise include all aspects of Soarian Financials Revenue Management including Service Catalog (CDM), Service Maps, CRDT, General Ledger, Contracts, Claims, Reports, and all Master Files. Alison has provided analysis and reconfiguration for optimization, new build services, legacy support for hospital systems moving to a new platform, and training.Disclosure: Alison Kazmierczak has no Relevant Financial or Non-Financial Relationship with ineligible companies to disclose.
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