Course Code: REL-RCC-OPPS-C04
Hours: 0.5
Type: Online Course
Content Expiration Date: 12/31/2025
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.
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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.
Course Delivery Method and Format
Asynchronous Distance Learning with interactivity which includes quizzes with questions/answers, and posttests.