Revenue Cycle: Hospital Outpatient


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This course is recommended as a prerequisite to our other hospital-based CPT coding courses.  It introduces the concept of hospital outpatient revenue cycle, including hard and soft coding, outpatient bill presentation, revenue codes, payer mix, and the outpatient prospective payment system (OPPS).  It includes an overview of the OPPS with a description of APCs, status indicators and packaging.  The outpatient code editor and NCCI and MUE edits are also covered along with hospital-approved modifiers and their usage.  Other concepts integral to the hospital outpatient coding process are also discussed, such as device C codes and pass through payments for devices and drugs.  The course rounds out instruction with a listing of official coding resources for the hospital outpatient coding setting, instruction on how to use the Medicare Coverage Database, and a description of the agencies employed by CMS to audit and investigate Medicare fraud and abuse.


Lesson 1:

  • Differentiate between hard coded and soft coded codes
  • Recall the importance of bill presentation
  • Indicate how Medicare pays for services
  • Determine how often APC updates are released

Lesson 2:

  • Match APC status indicators to their respective definitions
  • Determine when payments for certain services are packaged into payments for other services
    Use the NCCI tables to determine when certain services are bundled into others
  • Identify modifiers that are applicable in the hospital setting

Lesson 3:

  • Indicate the official resources for OPPS billing
  • Utilize the Medicare Coverage Database to locate coverage criteria
  • Identify agencies who investigate Medicare fraud and abuse

Target Audience

  • Facility Outpatient Coders
  • Billing Professionals
  • Revenue Integrity Professionals
  • Charge Master Analysts
  • Coding Compliance Professionals

CE Credits

AHIMA This program has been approved for 2 continuing education unit for use in fulfilling the continued education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.

AAPC This program has the prior approval of the American Academy for Professional Coders (AAPC) for 2 continuing education hour. Granting of prior approval in no way constitutes endorsement by AAPC of the program content or the program sponsor.

Purchasing Details

  • Upon purchase, you will have a 6-month subscription to this course. This will allow you the opportunity to complete and review as often as you like for 6 months.
  • Courses are accessed through
  • Visit our FAQ page for technical requirements and additional details.


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