Question

Ashley attended an in-service education program about the outpatient prospective payment system (OPPS) where she learned that certain Medicare Part B services are paid according to ambulatory payment classifications (APCs), which group services according to similar clinical characteristics and in terms of resources required. A payment rate is established for each APC and, depending on services provided, hospitals may be paid for more than one APC for a patient encounter. As part of the in-service, Ashley is provided with the following information and required to answer each question by applying the formula to calculate APC payments. Outpatient Prospective Payment System (OPPS) Formula (APC Weight Conversion Factor Wage Index) + Add-On Payments Payment NOTE: When a patient undergoes multiple procedures and services on the same day, multiple APCs are generated and payments are added together. APC software automatically discounts multiple APC payments when appropriate (e.g., bilateral procedure) onversion Factor $68.75 age Index 0.9445 HCPCS Code ription taract procedure with intraocular lens implant PC Weight 4.56 984 71046 78740 APC 46 260 92 hest x-ray, 2 views 1.56 reteral reflux study 94 What is the APC payment for HCPCS code 66984? Round the answer to two decimal points

Please show the amounts I should be adding.

Answer 1

Calculating the APC payment for HCPCS code 66984

Given,

APC weight 24.56

Conversion factor CF $68.75

Wage Index 0.9445

In this case there is no add-on payment

Now,

According to the OPPS formula :

Payment = APC weight $\times$ Conversion factor $\times$ Wage Index

That is,

Payment = 24.56 $\times$ $68.75 $\times$ 0.9445

Payment = $1,594.79

If it is a rural SCH, then there there is an add-on payment : Payment $\times$ 0.071

That is,

$1,594.79 $\times$ 0.071 = $113.23

Then the payment will be,

$1,594.79 + $113.23 = $1,708.02