AHA Coding Clinic® for HCPCS - 2001 Quarter 4; FOR your INFORMATION
Clarification of hospital outpatient payments made under the Outpatient Prospective Payment System (OPPS)
A recently published Program Memorandum (PM) Transmittal A-01-133, addresses packaged services under the outpatient prospective payment system (OPPS). The purpose of this PM was to render advice on how to handle packaged services submitted on claims from hospital outpatient departments (bill types 12X, 13X, and 14X). The Centers for Medicare & Medicaid Services (CMS) felt that this PM was necessary because it was brought to their attention that hospital outpatient claims containing services that would be packaged services if an Ambulatory Payment Classification (APC) were payable, are not being properly handled. Packaged services are items and services that are...
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Article Overview
This article summarizes CMS guidance on outpatient hospital payment processing under the Outpatient Prospective Payment System (OPPS). It focuses on the handling of packaged services on hospital outpatient department claims, the role of APC-based payment, and the affected hospital outpatient bill types. It is relevant to outpatient hospital coders, billing staff, and revenue cycle teams working with Medicare claim payment rules.
Why This Topic Matters
Correct handling of outpatient packaged services affects whether hospital outpatient claims are processed as expected under OPPS. The article helps readers understand the scope of CMS clarification and the types of claims and payment structures involved.
What You Will Learn
- The general purpose of CMS guidance on outpatient hospital payment clarification
- How packaged services are discussed in the context of OPPS claims processing
- Which hospital outpatient bill types are addressed
- How APC-based payment is referenced in relation to outpatient packaging
Who Should Read This
- Hospital outpatient coders
- Outpatient billing staff
- Revenue cycle professionals
- Medicare compliance teams
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