Medicare's Outpatient Prospective Payment System: Understanding OPPS Edits

Hours: 0.50
# Course Code: REL-RCC-OPPS-C07

This course explains the function of the Outpatient Code Editor (OCE), including the National Correct Coding Initiative (NCCI) edits, in the processing of Outpatient Prospective Payment System (OPPS) claims. The course will cover Procedure to Procedure (PTP), Medically Unlikely Edits (MUEs), and Add-on Edits within the NCCI edits.

Course Description

This course explains the function of the Outpatient Code Editor (OCE), including the National Correct Coding Initiative (NCCI) edits, in the processing of Outpatient Prospective Payment System (OPPS) claims. The course will cover Procedure to Procedure (PTP), Medically Unlikely Edits (MUEs), and Add-on Edits within the NCCI edits.

Certificates

Certificates provided by accrediting body (2 Match)

American Health Information Management Association

0.5 HOURS

“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.”

American Academy of Professional Coders

0.5 HOURS

This activity is approved for 0.5000 contact hours.

Course Details

Course Code: REL-RCC-OPPS-C07

Hours: 0.5

Type: Online Course

Content Expiration Date: 3/31/2024

Learning Objectives:
Recall the function of the OCE edits.
Identify which OCE edits include the PTP edits.
Recognize how the MUEs work.
Locate Add-on edits.
Understand the distinctions among OCE edits, NCCI edits, PTP edits, and MUEs.

Outline:

Section 1: Introduction

About This Course

Learning Objectives

Section 2: Integrated Code Editor

Integrated Outpatient Code Editor Background

Integrated Outpatient Code Editor Software

Section 3: OCE Edits

Current OCE Edits

Current OCE Dispositions

Review

Sample RTP Edits

OCE Edit 17 Associated with the Bilateral Modifier

OCE Edit 74 Associated with the Bilateral Modifier

OCE Edit 21

OCE Edits Associated with Observation Services

Review

Section 4: PTP Edits

OCE Edits and NCCI Edits

Procedure to Procedure (PTP) Edits

Allowable Modifier Designation

Non-modifiable NCCI Edits: OCE Edit 20

Modifiable NCCI Edits: OCE Edit 40

Review

NCCI Coding Policy Manual for Medicare Services

Section 5: Medically Unlikely Edits

Medically Unlikely Edits, Part 1

Medically Unlikely Edits, Part 2

Adjudication of Medically Unlikely Edits

Examples of Medically Unlikely Edits

Examples of Laboratory Medically Unlikely Edits

Review

Add-on Code Edits

Section 6: Conclusion

Course Summary

Course Contributor(s)

References

Glossary

Reviewer: Veronica Ziac, MBA

Veronica Ziac, MBA has over twenty years of healthcare administration experience. Her areas of expertise include revenue cycle, information systems, population health and physician practice management. Most recently, she was the Director of Revenue Cycle Integrity at Cobleskill Regional Hospital. Prior to that, Veronica was the Chief Operating Officer for a large multispecialty hospital-based physician practice based in New York. Veronica has an MBA in Healthcare Administration from Union College and a bachelor’s degree from the University at Albany. She is a member of HFMA and MGMA and has been Certified in Healthcare Compliance (CHC) by the Healthcare Compliance Association.
Disclosure: Veronica Ziac, MBA has no Relevant Financial or Non-Financial Relationship with ineligible companies to disclose.

Target Audience:
The target audience for this course is: Coding Specialists; in the following settings: Acute Care Facility.

Relias will be transparent in disclosing if any commercial support, sponsorship or co-providership is present prior to the learner completing the course.

Course Delivery Method and Format
Asynchronous/Online Distance Learning; please see certificate details for specifics on delivery format.
Relias has a grievance policy in place to facilitate reports of dissatisfaction. Relias will make every effort to resolve each grievance in a mutually satisfactory manner. In order to report a complaint or grievance please contact Relias.
If you require special accommodations to complete this module, please contact Relias Support by completing the web form (https://www.relias.com/help) or by using the chat functionality.
All courses offered by Relias, LLC are developed from a foundation of diversity, inclusiveness, and a multicultural perspective. Knowledge, values and awareness related to cultural competency are infused throughout the course content.
Reference herein to any specific commercial product, process, or service by trade name, trademark, service mark, manufacturer or otherwise does not constitute or imply any endorsement, recommendation, or favoring of, or affiliation with, Relias, LLC.
All characteristics and organizations referenced in the following training are fictional. Any resemblance to any actual organizations or persons living or dead, is purely coincidental.
To earn continuing education credit for this course you must achieve a passing score of 80% on the post-test and complete the course evaluation.

Accommodations
If you require special accommodations to complete this module, please contact Relias Customer Support here.

Medicare's Outpatient Prospective Payment System: Understanding OPPS Edits

$ 35.0 $35.00 $35.00

American Health Information Management Association

American Academy of Professional Coders

$ 35.0 $35.00

$35.00