HITT 2335-Chapter 7 Medicare Hospital Outpatient Payment System Exam Questions and Answers
Graded A+
CMS uses three reimbursement methods for outpatient services: - Answers fee schedule, prospective
payment, and reasonable costs
Ambulatory Payment Classification (APC) - Answers combines procedures and services that are clinically
comparable, with respect to resource use, into groups which are used to determine reimbursement
levels.
Ambulatory services under OPPS are paid via - Answers APC
APC group must meet the - Answers Two times rule
Two times rule - Answers establishes that the median cost of the most expensive item or service within
a group cannot be more than two times greater than the median cost of the least expensive item or
service within the same group
packaging and bundling are concepts used in - Answers OPPS to combine payment for multiple services
packaging - Answers Occurs when reimbursement for minor ancillary services associated with a
significant procedure is combined into a single payment for the procedure.
Bundling - Answers Occurs when payment for multiple significant procedures or multiple units of the
same procedure related to an outpatient encounter or to an episode-of-care is combined into a single
unit of payment.
Example of bundling - Answers critical care services, imaging, and mental health services
what kind of system is APC - Answers partially packaged
why was a partially packaged system created? - Answers to provide adequate reimbursement and allow
the treatment flexibility that is needed to care for patients in the outpatient setting
Each code in HCPCS has been assigned - Answers a payment status indicator (SI)
Payment status indicator (SI) - Answers Code that establishes how a service, procedure, or item is paid in
OPPS.
HCPCS codes are displayed in - Answers Addendum B of the OPPS final rule and updated quarterly
Outpatient Code Editor (OCE) - Answers Software program designed to process data for OPPS pricing,
including executing packaging and bundling logic. Additionally, the OCE edits the claim based on coding
and billing requirements.
APC contains - Answers a title, SI, relative weight, national unadjusted payment amount, national
unadjusted copayment amount and a code range.
Graded A+
CMS uses three reimbursement methods for outpatient services: - Answers fee schedule, prospective
payment, and reasonable costs
Ambulatory Payment Classification (APC) - Answers combines procedures and services that are clinically
comparable, with respect to resource use, into groups which are used to determine reimbursement
levels.
Ambulatory services under OPPS are paid via - Answers APC
APC group must meet the - Answers Two times rule
Two times rule - Answers establishes that the median cost of the most expensive item or service within
a group cannot be more than two times greater than the median cost of the least expensive item or
service within the same group
packaging and bundling are concepts used in - Answers OPPS to combine payment for multiple services
packaging - Answers Occurs when reimbursement for minor ancillary services associated with a
significant procedure is combined into a single payment for the procedure.
Bundling - Answers Occurs when payment for multiple significant procedures or multiple units of the
same procedure related to an outpatient encounter or to an episode-of-care is combined into a single
unit of payment.
Example of bundling - Answers critical care services, imaging, and mental health services
what kind of system is APC - Answers partially packaged
why was a partially packaged system created? - Answers to provide adequate reimbursement and allow
the treatment flexibility that is needed to care for patients in the outpatient setting
Each code in HCPCS has been assigned - Answers a payment status indicator (SI)
Payment status indicator (SI) - Answers Code that establishes how a service, procedure, or item is paid in
OPPS.
HCPCS codes are displayed in - Answers Addendum B of the OPPS final rule and updated quarterly
Outpatient Code Editor (OCE) - Answers Software program designed to process data for OPPS pricing,
including executing packaging and bundling logic. Additionally, the OCE edits the claim based on coding
and billing requirements.
APC contains - Answers a title, SI, relative weight, national unadjusted payment amount, national
unadjusted copayment amount and a code range.
