Revenue Cycle: Hospital Outpatient

Overview

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.