Course | Basic | Medicare Payment and Reimbursement
In this course we will address scheduling processes, including<div><ul><li>Patient identification</li><li>Requested service</li><li>Medical necessity screening</li><li>Medicare Advance Beneficiary Notice of Noncoverage processing</li><li>Pa...
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Course | Overview | Medicare Payment and Reimbursement
This course provides a brief history and overview of Medicare and Medicaid. It describes government organizations that regulate and administer this program. This course also discusses Medicare reimbursement. In addition, it highlights recen...
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Course | Intermediate | Medicare Payment and Reimbursement
This course provides an overview of the prospective payment systems used in the Medicare program and as well as Medicare fee schedules. This course provides a general discussion and overview of Medicare reimbursement under the Inpatient Pro...
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Course | Intermediate | Medicare Payment and Reimbursement
This course provides a general discussion and overview of reimbursement provided by Medicare under the outpatient prospective payment system. It also discusses the use of ambulatory payment classifications in the outpatient prospective paym...
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On Demand Webinar | Intermediate | Medicare Payment and Reimbursement
As the senior population continues to outpace the relative growth of the general population, and Medicare Advantage is accounting for about one-third (and growing every year) of all new Medicare eligible enrollees, providers are increasingl...
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Fact Sheet | Medicare Payment and Reimbursement

CY16 OPPS Final Rule Fact Sheet

Fact Sheet | Medicare Payment and Reimbursement

CY16 OPPS Final Rule Fact Sheet

This fact sheet highlights 2016 payment rate updates to outpatient hospitals and ambulatory surgical centers under the Medicare Outpatient Prospective Payment System (OPPS).

CMS released a final rule with comment period revising the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY16 to implement certain applicable statutory requirements and changes. In this final rule, CMS describes the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and the ASC payment system. The final rule also updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program, as well as the ASC Quality Reporting (ASCQR) Program. Further, the rule also includes certain finalized policies relating to the hospital inpatient prospective payment system (IPPS), including changes to the two-midnight rule under the short inpatient hospital stay policy; and a payment transition for hospitals that lost their status as a Medicare-dependent, small rural hospital (MDH), because they are no longer in a rural area due to the implementation of the new Office of Management and Budget (OMB) delineations in FY15 and have not reclassified from urban to rural before Jan. 1, 2016. The rule finalizes certain 2015 proposals and addresses public comments received, relating to the changes in the Medicare regulations governing provider administrative appeals and judicial review relating to appropriate claims in provider cost reports.

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