Outpatient Prospective Payment System

Hospital-Based Outpatient Clinics The Outpatient Prospective Payment System (OPPS) is the method for compensation for hospital-based outpatient facilities (DHHS, 2000a). With this system, there is a professional component (e.g., for physician providers) and a technical component (e.g., for nonphysician health care professionals) to billing that describes the various contributions of the health care team during the specific patient encounter. Ambulatory Payment Classification (APC) codes are used within this system to describe the type and complexity of the patient visit to the insurance company. When pharmacists provide services within a hospital-based clinic, the compensation for the service goes to the hospital facility instead of directly to the provider. The revenue generated should be able to be tracked internally as to which department or health care professional was involved in the care of the patient (Snella and Sachdev,... 

Centers for Medicare Medicaid Services. Hospital outpatient prospective payment system. August 2000. http //cms.hhs.gov/regulations/hopps, accessed March 13, 2003. 

Department of Health and Human Services (DHHS), Office of the Inspector General. 2000a. Medicare program, prospective payment system for hospital outpatient services. Fed Reg 65 18433 available at www.gpoaccess. gov/fr/. 

Medicare Hospital Outpatient Services Prospective Payment System (2001). Centers for Medicare and Medicaid Services proposed rules. Fed Regist 66 44671... 

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