Table of Contents
What is modifier PN used for?
Modifier PN – Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital. Used to identify and pay non-excepted items and services billed on an institutional claim.
What is the outpatient prospective payment system?
The Outpatient Prospective Payment System (OPPS) is the system through which Medicare decides how much money a hospital or community mental health center will get for outpatient care provided to patients with Medicare. The rate of reimbursement varies with the location of the hospital or clinic.
Which reimbursement scheme is used in the inpatient psychiatric facility prospective payment system?
CMS uses separate PPSs for reimbursement to acute inpatient hospitals, home health agencies, hospice, hospital outpatient, inpatient psychiatric facilities, inpatient rehabilitation facilities, long-term care hospitals, and skilled nursing facilities.
What is modifier PN and PO?
The modifier -PO requirement has not been removed, but its definition was change to include only “excepted” department services. Modifier -PN is used for “nonexcepted” departments.
Is APC the same as opps?
APCs are used in outpatient surgery departments, outpatient clinic emergency departments, and observation services. An OPPS payment status indicator is assigned to every CPT/HCPCS code and the indicators identify if the code is paid under OPPS and if it is a separate or packaged code.
Which type of hospital is excluded from the inpatient Prospective Payment System?
rehabilitation hospital
A rehabilitation hospital or unit must meet the requirements specified in § 412.29 of this subpart to be excluded from the prospective payment systems specified in § 412.1(a)(1) of this subpart and to be paid under the prospective payment system specified in § 412.1(a)(3) of this subpart and in subpart P of this part.
Is inpatient psychiatric facility PPS cost based or price based?
Inpatient Psychiatric Facilities Inpatient Psychiatric Facility (IPF) PPS classifications are based on a per diem rate with adjustments to reflect statistically significant cost differences.
What does APC pricing mean?
Ambulatory Payment Classifications
APCs or “Ambulatory Payment Classifications” are the government’s method of paying facilities for outpatient services for the Medicare program.
What is the difference between CPT and APC codes?
Surgical, significant and ancillary APCs are assigned using only the CPT-4 procedure codes, while medical APCs are based on the combination of the ICD-9-CM diagnosis code and the E&M CPT-4 code. HCFA also considered defining medical APCs based only on diagnosis code or only on E&M code.
How does APC pricing work?
The payments are calculated by multiplying the APCs relative weight by the OPPS conversion factor and then there is a minor adjustment for geographic location. The payment is divided into Medicare’s portion and patient co-pay. Co-pays vary between 20 and 40% of the APC payment rate.