Healthcare Reimbursement 530-185 OPPS Skill Assessment PART A: Describe the step

Question

Healthcare Reimbursement 530-185 OPPS Skill Assessment PART A: Describe the steps in calculating Hospital Outpatient PPS payment (25 points): Click here to enter text. PART B: For each of the given Case Studies, complete the table and corresponding questions if applicable. Enter your answers in the space or box provided (25 points each case) Case 1 A 73 year old Medicare patient was seen in the Senior Health clinic for a monthly appointment to evaluate hypertension. The patient is seen by the nurse practitioner, who checks the patient's blood pressure, evaluates the current medication dosage, and performs a limited examination. She reports the findings to the physician. The patient's medication is adjusted and the patient is sent home. The physician did not see the patient CPT Code(s): 99211 E&M;, office, established patient not requiring presence of MD DISCOUNTING HIGHEST PAYING CPT CODE APC WEIGHT SYOR N) CPT CODE 99211 If any modifiers (or N/A): 1. Definition of the modifier: 2. If or how it affects reimbursement:

Explanation / Answer

Hospital out patient PPS:
?    -Payments rates that are corrected retroactively for some drugs based on ASP methodology..These corrections occur on a quartely basis as a part of the OPPS payment system quartely update change request..
? -High mark payment method based on OPPS.This billing protocol applies in methodology except when high mark has communicated with benefit and coverage determinations..
? - Highmark allows all outpatient services,including observation,to be billed in inpatient bill for the same patient has not been submitted..
? -Highmark requires applicable change if no charge id submitted for any line,no changes will be charged for that..
? -Medicare hospitals outpatient prospective payment services and medicare ambulatory surgical centers payment system for cy2018 to implement changes under the 21st century cures Act.
? -In addition the final rule with OPPS require for the hospital outpatient Quality Reporting(QQR) program and ASC Quality Reporting(ASCQR) program..
   APC for Established patient not requiring presence of MD -0634
? Discounting-NA
? HIghest paying CPT code -19.21 dollar
?Modifier 25 when the modifier indicates that a seperately identifiable E/M service was perfromed that meets a higher complexity level of care than a service represented by procedure code 99211. E/M service code 99211 will not be reimbursed when submitted with a diagnostic or therapeutic injection code with or without modifier 25..

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