This lesson will provide background regarding the development of the Ambulatory Payment Classification (APC) system for the Outpatient Prospective Payment System (OPPS), as well as a general understanding of the services covered.
“This program has been approved for 0.50 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 0.50 contact hours.
Section 1: Introduction
About This Course
Section 2: OPPS Updates
Balanced Budget Refinement Act
Updates to the Outpatient Prospective Payment System
Section 3: Medicare Part B
Medicare Plans and OPPS
Part B Hospital Outpatient Services Not Covered Under OPPS
Section 4: APC Basics
Basics of APCs
Section 5: APC Payments
Payments Under OPPS: Part 1
Payments Under OPPS: Part 2
Introduction to Status Indicators
Packaged APC Services
Separately Paid APC Services
Key CMS Websites Surrounding OPPS
Section 6: Conclusion
Expert Reviewer: Richard R. Cooley, BA, CCS
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 declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
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 declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
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