Medicare's Outpatient Prospective Payment System: Part B Payment Systems

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

Exclusions from Coverage

Review

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

References

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.

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.