Hospitals: GETTING IT RIGHT ON OPPS MULTIPLE-PROCEDURE CLAIMS
A hospital's misunderstanding of outpatient prospective payment system billing rules has caught the attention of the HHS Office of Inspector General.
As Mercy Hospital was transitioning to OPPS, it mistakenly believed that only one surgical procedure could be claimed each time an operating room was used. As a result, when multiple procedures were performed during a single OR session, the hospital claimed ambulatory payment classification reimbursement for just one of the procedures.
That meant that Mercy received far less than it deserved in APC payments - but too much in subsequent outlier payments, the OIG maintains in "Review of...
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