Question

Please fill the following tables for the ambulatory care prospective payment systems:

	HOPPS Payment Process	ASCPPS Payment Process	ESRD Payment Process	HSPS Payment Process
Type of code used to determine the payment and the process by which the code is arrived at (write a few sentences for the process)
Patient data that must be presented with the claim
Facility level adjustments
Patient level adjustments
Outlier payment processes, if applicable (write a few sentences for the process)
Other adjustments, if any

Answer 1

Type of code used to determine the payment and the process by which the code is arrived at (write a few sentences for the process)

HOPPS payment process:

• Claims are identified In divided in two or “single procedure claims and multiple procedure claim
• Multiple procedure claims can’t be used for rate setting because the rates are set for each procedure
• If a claim has two or more payable procedures with other packed items, the dilemma is how to apportion the packaged cost to each procedure
• Types of codes need to assign here is CPT, HCPCS

ASCPPS Payment process;

The ASC final rule (CMS 1517F) published the policies for the revised payment process

Codes need to be assigned here is CPT,HCPC and ICD -10 Codes

ESRD payment process:

ESRD payment process is based on Risk of the patient mainly ICD weightage

HSPS Payment process:

HSPS payment method is CPT HCPCS and ICD for payment determination

Patient data that must be presented with the claim

HOPPS payment process: yes patient data is required to process the claim

ASCPPS Payment process; yes patient data is required to process the claim

ESRD payment process: yes patient data is required to process the claim

HSPS Payment process: minimal patient data is required

Facility level adjustments

ASCPPS Payment process; Applicable facility level adjustments

HOPPS payment process; Applicable facility level adjustments

ESRD payment process; Applicable facility level adjustments

HSPS Payment process: not applicable facility adjustments