Wiki Opps

[TMB1965]

What does this mean "Bill OPPS Medicare Charges" I'm lost, so any help as to what this means would be greatly appreciated!

 

[philipwells]

Outpatient Prospective Payment System "OPPS" Seems like it's asking for you to bill the outpatient hospital charges.

I'd have to know a little more about what you're trying to bill in regards to this question.

 

[TMB1965]

The original charges were 99212 with 11900 for a surgical office, and now I'm being told they need to be billed with the appropriate OPPS Medicare charges. Are they maybe referring to charges for the facility too?

 

[mitchellde]

A surgical physician office would not bill under OPPS. Are you in an outpatient setting? What POS did you bill with? Are you set up to bill as a CMS 1500 claim or the UB04 claim? Who is the one telling you to bill this way?

 

[TMB1965]

So OPPS Billing is strictly for hospital outpatient? Where can I find the guidelines on OPPS Billing?

 

[mitchellde]

Yes it is outpatient reimbursement. You can research OPPS on line, looking under OPPS and or APC (ambulatory procedure classification)

 

[TMB1965]

I found it, so thanks for your help!