Medicare's Outpatient Prospective Payment System: Part B Payment Systems
Hours: 0.50
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 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).
American Health Information Management Association
“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
This activity is approved for 0.5000 contact hours.
American Health Information Management Association
“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
This activity is approved for 0.5000 contact hours.
Identify services that are reimbursed under the Outpatient Prospective Payment System (OPPS).
Recognize the APC system.
Recall what services are paid outside of OPPS.
Identify exclusions from Medicare Part B.
Outline:
Section 1: Introduction
About This Course
Learning Objectives
Section 2: OPPS Basics
Overview
OPPS Services
Review
Section 3: APCs
OPPS and APCs
Coinsurance
Clinical Example of APC-Covered Services
APC-Paid Laboratory Studies
Pathology Example
Section 4: Excluded and Ancillary Services
Other Outpatient Payment Methods: Physician Payment
Payment for Therapy
Fee Schedule for Laboratory Studies
Review
Exclusions from Coverage
Section 5: Other Services
End-Stage Renal Disease and Outpatient Maintenance Dialysis
Payment for Ambulance Services
Review
Critical-Access Hospitals
Review
Section 6: Conclusion
Course Summary
Course Contributors
Resources
Bibliography
References
Instructor: Richard R. Cooley, BA, CCS
Expert Reviewer: Jean C. Russell, MS, RHITRichard 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.
Instructor: Alison KazmierczakJean 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.
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 declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
The target audience for this course is: Coding Specialists; in the following settings: Acute Care Facility.
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.
If you require special accommodations to complete this module, please contact Relias Customer Support here.
Access to over 1,450 courses! Access to 1,450+ courses for one low price.
