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Medicare's Outpatient Prospective Payment System: Calculating APC Payments

Green Clock Hours: 0.50

This course explains the Outpatient Prospective Payment System (OPPS) payment provisions, focusing primarily on the calculation of adjusted Ambulatory Payment Classification (APC) amounts, taking into consideration such things as coinsurance, deductibles, and geographic adjustments.

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$35.00

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Course Description

This course explains the Outpatient Prospective Payment System (OPPS) payment provisions, focusing primarily on the calculation of adjusted Ambulatory Payment Classification (APC) amounts, taking into consideration such things as coinsurance, deductibles, and geographic adjustments.

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-C04
Hours: 0.5
Type: Online Course
Content Expiration Date: 3/31/2024
Learning Objectives:
Apply computations for provider-specific APC payment rates.
Recall how geographic location affects adjustments.
Determine when APC payments are subject to discounting.
Recall deductible amounts for Medicare Part B.
Correctly calculate coinsurance amounts.
Recall pass-through payments for drugs.
Recognize the impact modifiers -52, -73, and -74 have on APC reimbursement.

Outline:

Section 1: Introduction

About This Course

Learning Objectives

APC Payment Groups

Section 2: Rates

Determining APCs and APC Rates: Addendum A

Determining APCs and APC Rates: Addendum B

Determining APCs and APC Rates: Addendum M

Calculation of APC Rates and Weights

Review

Section 3: Calculations

Establishing the OPPS Conversion Factor

Rates Calculated from Weights

Use of Modifiers for Discontinued Services

Discounting

Review

Calculating Hospital-Specific Payments

Payment Rate Calculation

Example of Hospital Payment

Review

Section 4: Payments

OPPS Coinsurance

Deductible

Calculating Payments with Deductibles and Coinsurance

Outlier Payments

Sample Outlier Payment Calculation

Review

Section 5: Conclusion

Course Summary

Course Contributors

Resources

References



Glossary


Subject Matter Expert: Jean C. Russell, MS, RHIT

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.

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.
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