AMA CPT® Assistant - 2001 Issue 1 (January)
Outpatient Reporting-Hospital Outpatient Prospective Payment System (OPPS) (January 2001)
January 2001 pages 3-7 Coding Update Outpatient Reporting-Hospital Outpatient Prospective Payment System (OPPS) On April 7, 2000, the Health Care Financing Administration's (HCFA) final regulation to implement Medicare's Hospital Outpatient Prospective Payment System (OPPS) was published in theFederal Register. The new Medicare payment system for hospital outpatient services was implemented effective July 1, 2000. OPPS outlines provisions related to providerbased facilities owned by hospitals, including physician office practices. The new payment system is based on groups of services called "ambulatory payment classifications (APC)," which divide all outpatient services included in the new payment schedule into 451 groups. The...
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Article Overview
This article explains the January 2001 Medicare Hospital Outpatient Prospective Payment System (OPPS) update from HCFA. It covers the overall APC framework, categories of services included or excluded, treatment of outpatient visits and partial hospitalization, multiple-procedure payment issues, annual update provisions, and implementation-related billing and system changes. The article is aimed at hospital outpatient coding, billing, and reimbursement professionals who need to understand how the outpatient PPS was structured and updated at that time.
Why This Topic Matters
OPPS changes affect how hospital outpatient services are grouped, billed, and paid, so coding and reimbursement staff need a clear understanding of the system’s structure and related implementation updates.
Article Sections
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Coding Update
Overview of the Medicare outpatient payment system update and the general framework used for hospital outpatient services. Introduces the scope of the article and the regulatory context.
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Hospitals Excluded from the OPPS
Describes which hospital types are outside the outpatient payment system and notes special payment protections discussed in the update.
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Scope of Services Covered Under the OPPS
Summarizes broad categories of outpatient services included in or excluded from the payment system and discusses service types addressed by separate payment methods.
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Inpatient Procedures Moved to the Outpatient List
Reviews the shift of certain procedures from inpatient-only status to outpatient coverage and discusses related setting requirements and exclusions.
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Packaging Under the APC System
Explains how related hospital resources and items are bundled into APC payment and identifies categories discussed as exceptions to packaging.
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Treatment of Clinic and Emergency Department Visits
Covers the payment approach for clinic and emergency department visits, including the shift in how visit groups are structured and handled under OPPS.
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Treatment of Partial Hospitalization Services
Summarizes the OPPS approach to partial hospitalization, including provider settings, service categories, and the per diem structure discussed in the article.
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Discounting for Multiple Surgical Procedures
Describes the multiple-procedure payment discussion under OPPS and the broader treatment of same-session surgical services.
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Cancer Centers and Small Rural Hospitals
Addresses the special hold-harmless protections discussed for certain hospital categories under the outpatient payment system.
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Annual Updates
Notes the annual review and update process for payment groups, weights, and related adjustments under the outpatient PPS.
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Implementation Plans and Actions
Covers operational preparations for OPPS implementation, including billing changes, software tools, edits, and training activities.
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OPPS Errata
Lists corrections and updates issued for the outpatient payment system tables and related APC assignments.
What You Will Learn
- How OPPS structures hospital outpatient payment using APC groupings
- Which categories of outpatient services are covered, excluded, or separately paid
- How outpatient visit services and partial hospitalization are addressed under the update
- How the article discusses packaging, multiple procedures, and implementation preparations
- What types of errata and APC updates were issued in connection with the OPPS material
Who Should Read This
- Hospital outpatient coders
- Hospital billing staff
- Reimbursement specialists
- Revenue cycle professionals
- Compliance staff
- PPS implementation teams
Codes Discussed
Code Ranges Discussed
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