Medicare Outpatient Reimbursement Fundamentals

Medicare outpatient reimbursement is crucial for healthcare professionals navigating the complex landscape of healthcare finance. This course offers a comprehensive exploration of the reimbursement methodologies, regulations, and challenges associated with Medicare outpatient services.

In this course, you will delve into the intricacies of the Medicare Outpatient Prospective Payment System (OPPS), including its evolution, key components, and payment methodologies. The course will examine the factors influencing outpatient reimbursement rates, including annual recalibrations and cost reporting impacts. You will also explore exceptions, exclusions, and regulations impacting Medicare outpatient reimbursement, enabling you to navigate compliance requirements effectively.

Course Outline:

• Section 1: Course Introduction
• Section 2: Outpatient Prospective Payment System (OPPS)
• Section 3: Ambulatory Surgical Center (ASC)
• Section 4: Ambulance Services
• Section 5: Clinical Diagnostic Laboratory Services
• Section 6: Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)
• Section 7: End-Stage Renal Disease (ESRD) Services
• Section 8: Mammography Services
• Section 9: Hospital Outpatient Rehab and Therapy Services
• Section 10: Course Assessment

When you complete this course, you’ll be able to: 

• Develop skills to navigate compliance requirements.
• Identify the evolution, key components, and payment methodologies of the Medicare Outpatient Prospective Payment System (OPPS).
• Examine the factors influencing outpatient reimbursement rates.
• Explore exceptions, exclusions, and regulations impacting Medicare outpatient reimbursement.

CPE Information:

CPE Award Amount: 2.0

Program Level: Basic

Program Prerequisite: None

Recommended Experience: Revenue cycle staff, reimbursement professionals, managed care contracting professionals, and financial professionals operate at various levels.

Advanced Preparation: None

Instructional Method: QAS Self-Study

Delivery Method: QAS Self-Study

Field of Study and Topic in hours: Specialized Knowledge – 2.0

CPE Sponsor: Healthcare Financial Management Association is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors. State boards of accountancy have final authority on the acceptance of individual courses for CPE credit. Complaints regarding registered sponsors may be submitted to the National Registry of CPE Sponsors through its website: www.nasbaregistry.org.

For more information regarding refund policies, as well as any program concerns, please contact our offices at 800.252.4362 or, [email protected].

CHCRS Program Enrollment:

The CHCRS designation is earned and awarded upon successful completion of two prerequisite courses, hospital cost report training and CHCRS exam.

Step 1 – Complete the two CHCRS program prerequisite courses. These courses can be taken in any order. A certificate is awarded on completion.

• Prerequisite Course: Medicare Outpatient Reimbursement Fundamentals
  • Cost: Member Included, Non-Member $99
• Prerequisite Course: Medicare Inpatient Reimbursement Fundamentals
  • Cost: Member Included, Non-Member $99

Step 2 – Complete the hospital cost report training. There are two options available.

• Option 1: Complete the HFMA hospital cost report online training course
  • Cost: Member $349, Non-Member – $549.
• Option 2: Complete the FORVIS led virtual cost report training
  • Link: forvis.com/events. Fees apply.
• Step 3 – Successfully complete the CHCRS exam*. When you successfully complete the exam, you will be awarded the CHCRS CPE certificate, digital badge, and designation. Member Included, Non- Member – $200.

* CHCRS Exam Prerequisites: Successful completion of two prerequisite courses and hospital cost report training is required to enroll in the CHCRS exam.

General Program Information