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

Course Code: REL-RCC-OPPS-C02

Hours: 0.5

Type: Online Course

Content Expiration Date: 12/31/2028

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: 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.