AHA Coding Clinic® for HCPCS - 2002 Issue 2; For your information

Changes to outlier payment for OPPS services

Outlier payments have been calculated collectively for all OPPS services that appear on a claim since the beginning of OPPS, August 1, 2000. Beginning, April 1, 2002, the OPPS Pricer will calculate outlier payments based on each individual OPPS service. Billed charges will continue to be converted to costs utilizing a single overall hospital-specific cost-to-charge ratio in calculating outlier payments. The costs attributable to all packaged items and services that appear on a claim will be allocated to all the OPPS services that appear on the claim. The amount allocated to each OPPS service is based on the percent...

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