This course 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.
- 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
- 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
- Indicate the official resources for OPPS billing
- Utilize the Medicare Coverage Database to locate coverage criteria
- Identify agencies who investigate Medicare fraud and abuse
**The price of this product includes the AMA Royalty Fees.