Medical Billing Blogs

  Medicare is one of the healthcare industry’s fastest-growing federal health-insurance programs. With so many patients dependent on Medicare for outpatient services, hospital expenditures are constantly increasing. To cover so many Medicare patients, this causes a financial imbalance in the hospital budget. Keeping this in mind, CMS developed the Outpatient Prospective Payment System (OPPS) to monitor outpatient service expenses better. This keeps hospitals from running into financial difficulties while delivering outpatient services to thousands of Medicare beneficiaries. Purpose of Decoding Device Billing: The OPPS permits CMS to pay hospitals an agreed-upon sum for Medicare outpatient services. This approach dramatically improves CMS’s ability to foresee and manage programs. It should be noted that the OPPS system is based on the Ambulatory Patient Classification (APC) methodology. To ensure the success of the OPPS, CMS allocates HCPCS codes to APC, which are changed annually. ...

  Medical billing consists of hundreds of pages of updated rules, regulations, and legislation, not to mention thousands of billing codes. And, navigating them is already a challenge for practices. Over the last few years, patients and insurers have continued to pressure the health system and hospitals to move towards ambulatory surgery centre (ASC) billing from hospital outpatient department billing (HOPD). The reason is ASCs billing can be a cost-saving procedure. But to understand how it can be cost-saving, one needs to understand the difference between ASC and HOPD. The Difference between ASC & HOPD The primary difference between ASC and HOPD is based on the regulations that apply to the centres. For instance, a stand-alone surgery centre can still be termed as HOPD when it falls under the same administrative and financial contracts as a hospital that is within a 35-mile radius. On the other hand, a facility can have the ASC status despite being operated by a hospi...