Medicare's Hospital Outpatient Prospective Payment System: OPPS 101 (part 1 of 2)

Guidi, Teri U.
November 2010
Journal of Oncology Practice;Nov2010, Vol. 6 Issue 6, p321
Academic Journal
The article offers information on the hospital outpatient prospective payment system (OPPS) established by the U.S. Centers for Medicare and Medicaid Services (CMS). It says that the OPPS sorts out all hospital services into Ambulatory Payment Classifications (APCs) and the CMS assigns Healthcare Common Procedure Coding System (HCPCS) codes to APCs. It says that the OPPS subjects all institutions licensed as hospitals, or those billing for outpatient services using CMS 1450 form (UB04). It also states that the CMS establishes the costs for each APC, which are calculated using national, total data from hospital claims and cost reports. It adds that hospitals under OPPS may only bill for services provided at the hospital's expense.


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