Certified Inpatient Coding (CIC) Practice Exam

How are outpatient services categorized for payment under OPPS?

1. APC groups

2. MS-DRGs

3. Diagnosis codes

4. HCPCS level II codes

The correct answer is: APC groups

Outpatient services are categorized for payment under the Outpatient Prospective Payment System (OPPS) using Ambulatory Payment Classifications (APCs). APCs group similar types of outpatient services into categories that can be reimbursed at a fixed, predetermined rate. This system takes into account factors such as the complexity and resources required for each procedure or service, facilitating standardized payments to providers and ensuring that similar services are billed and paid uniformly. The methodology allows hospitals and other outpatient facilities to predict revenue based on the services they provide and helps streamline the billing process. Additionally, APCs align with the goal of cost efficiency and transparency in outpatient services. They are crucial for coding professionals to understand, as they directly impact the payment process and reimbursement for services rendered.