Course Code: REL-RCC-OPPS-C02
Hours: 0.5
Type: Online Course
Content Expiration Date: 12/31/2025
Learning Objectives:
Identify services that are reimbursed under the Outpatient Prospective Payment System (OPPS).
Describe 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
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
Reviewer: 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.
Reviewer: Alison Kazmierczak
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.
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.