Course Code: REL-RCC-OPPS-C04
Hours: 0.5
Type: Online Course
Content Expiration Date: 12/31/2028
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
Reviewer: Brandi D. Burgett, CCS, CPC
Brandi has over twenty-five years of medical billing and coding experience. Her areas of expertise include beginning-to-end revenue cycle operations, hands-on coding for multiple outpatient specialties, and medical record auditing. Prior to medical coding, Brandi was a Team Lead for a large team of pediatric specialty providers in Virginia.
Target Audience:
The target audience for this course is: Healthcare Billing and Coding; in the following settings: Hospitals: Acute.
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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.