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Found inside – Page 165The project was conducted in five sequential phases : o Phase I Procedures Develop Procedural Costing Methodology for Cataract ... extensive research was conducted regarding HCFA's regulations and reimbursement methodologies for ASCs . Found insideThe reimbursement methodology needs to be evaluated by the specific plan chosen by the beneficiary. payment system Outpatient This payment plan is focused on patients with ESRD. dialysis services payment system Outpatient hospital ... Found inside – Page 329Note: New York State will phase in ambulatory patient groups (APGs) as a new payment methodology for most Medicaid outpatient services (e.g., outpatient clinic, ambulatory surgery, and emergency department services). o HMO outpatient reimbursement in the capitation rates could be based on EAPG's starting in CY2015. 0000001256 00000 n
During the hospital stay, the admitting physician typically makes frequent visits to the hospital and performs an inpatient E/M service at each visit. based on the APCs under the OPPS system. This means a coding professional manually codes the medical service or procedure. An ambulatory surgery center (ASC) is a distinct entity that operates to provide same-day surgical care for patients who do not require inpatient hospitalization. PHPs will be allowed to negotiate inpatient and outpatient reimbursement for behavioral health claims with hospitals. 107 18
Shield (MSBCBS) APC based reimbursement payment methods for acute care hospital outpatient services. Found inside – Page 214BILLING AND REIMBURSEMENT CHET SZERLAG , MBA , FACHE , CMPE , LUIS CANOVAS , CPC TABLE 16-2 . ... US Health Care Payment Methodologies Service Type Payment Calculation Methodology Inpatient hospital Outpatient hospital Physician's ... With the shift to value-based healthcare, more procedures are being performed in ambulatory surgery centers (ASCs). The files are available on Medicare’s ASC Payment Rates – Addenda page. Outpatient reimbursements for children's hospitals were historically based on 100 percent of allowable outpatient costs. Here are the five most common methods in which hospitals are reimbursed: Discount from Billed Charges. Found inside – Page 64The percentage of charges methodology is also known as fee - for - service . ... HOW MEDICARE REIMBURSES HOSPITALS FOR OUTPATIENT SERVICES Diagnostic - Related Groups and the Prospective Payment System In 1983 , Medicare adopted a ... Coding and Reimbursement Methodologies HITT 2435 (4 semester credit hours) Spring 2013 - Regular Term (crn 30479) Instructor Information Jeannie Helton, RHIT,MA . a. a. Found inside – Page 24Part B is amended by adding at the end the following new section : " PRESCRIPTION DRUG PAYMENT REVIEW COMMISSION " SEC . 1846. ( a ) ( 1 ) The Director of the ... ( 6 ) Alternative payment methodologies for covered outpatient drugs 24. The electronic version of this form is called the 837I (Institutional), the ANSI ASC X 12N 837I, or the American National Standards Institute Accredited Standards Committee X12N 837I (Institutional) Version 5010A2. Discount from Billed Charges. approved outpatient hosp ital reimbursement me thods submitted by 32 states over a four-year period, and only 1 state (not named) used methods that may be minimally affected by the rule. The EAPG reimbursement methodology is utilized to group payment for similar significant procedures when billed on an outpatient hospital claim, such that only the most resource-intensive significant procedure will be payable per visit, as determined by the EAPG algorithm. Table 1. It is not only imperative that facility coders understand outpatient coding guidelines, but also that they have a clear understanding of the UB-04 claim form and data needed to support a clean claim. This includes validating the patient’s demographic and insurance information, type of service, and any preauthorization for procedures required by the insurance company, if not already completed prior to the visit. Many of the services are packaged and paid based on the Ambulatory Payment Classification (APC) system. For instance, suppose a specialist, such as a cardiologist or gastroenterologist, provides a consultation for a patient in the emergency department of a hospital. Payment for laboratory will be made at the Medicaid laboratory fee schedule and x-ray will be paid at the professional fee schedule. Next, it is difficult, if not impossible, to judge the quality of competing services. Found inside... ofthe specific reimbursement methodologies relatedtothe MPFSand OPPS, see Section 2.4.1.3.1.2, “Hospital Outpatient ... 259 Priortothe DRA,the MPFS reimbursed forcertain imaging services provided inan outpatient settingat a higher ... The APC payment methodology for outpatient services is analogous to Diagnosis-Related Groups (DRGs) under the Inpatient Prospective Payment System (IPPS) that Medicare uses to reimburse facilities for inpatient hospital medical services and procedures. Hospital Outpatient Prospective Payment System Rulemaking. based on inflatn index and geographic wage index). There will be an add-on reimbursement of $7.79 for compound drugs, which will be in Found insideCMS recently implemented a prospective reimbursement methodology for outpatient services.119 Outpatient hospital services are reimbursed pursuant to an Ambulatory Payment Classification (“APC”) system. The APC system organizes ... Reimbursement methods for services provided to patients receiving care or treatment in an outpatient facility setting can differ depending on the payer type (government or commercial) or the type of service (such as ambulance). The ICD-10-CM code set is updated annually in October by the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics (NCHS). Any inaccuracies with the billing or coding should be remedied prior to claim submission. Assignment Requirements Please complete all parts in a Microsoft Word document. OHCA may share this personally identifiable data with its authorized business associates, government agencies with jurisdiction over the OHCA, or as otherwise required or permitted by applicable law. 0000001340 00000 n
Change in Outpatient Reimbursement Methodology...12. The final payment is calculated by multiplying the RVUs by the associated conversion factor, with a slight adjustment based on the geographic location. 0000033328 00000 n
Medicare updates the HCPCS Level II code set quarterly, with a major update Jan. 1 featuring codes and extra content such as the index. Articles Somber Ceremony at DHA Headquarters Evokes Vivid Memories of 9/11 Vivid memories and somber reflections marked an emotional ceremony at Defense Health Agency headquarters on Friday as the military medical community remembered and honored the victims of the terrorist attacks of Sept. 11, 2001. An ASC is a type of outpatient facility that can be an extension of a hospital or an independent freestanding ASC. Coding rules, including modifier use, also can vary by setting. CBO estimates that this rule will reduce federal Medicaid outlays by $0.3 billion over 5 years and $0.7 billion over 10 years.9 A recent congressional report OPPS hospitals are not limited to reporting C codes, but they use these codes to report drugs, biologicals, devices, and new technology procedures that do not have other specific HCPCS Level II codes that apply. As discussed in the introduction to this Benchmarking Study, WDH conducted an analysis of reimbursement information for each Medicaid service area. Methods: The PearlDiver database was employed to identify all inpatient and outpatient UKAs performed between 2007 and 2016 with 2-year follow-up. The claim form used for billing depends on the type of facility. 4. Navigating the healthcare coding and reimbursement sector can be complex as there are varying rules and guidelines that are not always transparent. Under the IPPS, each case is categorized into a DRG, which has a payment weight assigned to it, based on the average resources used to treat Medicare patients in that DRG. The various situations reflect whether: • The services include or exclude professional services • The IHS or tribal 638 health facility is set up to bill outpatient services with specific coding and Example of UB-04 (CMS-1450) Institutional Claim Form, Figure 2. CPT® codes represent medical services and procedures such as evaluation and management (E/M), surgery, radiology, laboratory, pathology, anesthesia, and medicine. Items and Services Not Billable to the MAC, Items and Services Packaged into APC rates. For Never Events all supplies and services for treatment of the Never Event will be removed from the claim prior to reimbursement. 0000032972 00000 n
As Table 1 illustrates, the methodologies may differ depending on a specific situation. However, the primary outpatient hospital reimbursement method used is the OPPS. (d) Outpatient hospital imaging. These are only a couple of examples of the types of rules outpatient facility coders need to know. AHIMA DOMAINS, SUBDOMAINS, AND TASKS 2. Hospital Outpatient Prospective Payment System Rulemaking. APCs or "Ambulatory Payment Classifications" are the government's method of paying facilities for outpatient services for the Medicare program. Excerpt of OPPS Payment Status Indicators for CY 2021. It is important that hospital managers and outpatient facility coders stay actively engaged with the rulemaking notices and publications for the hospital OPPS. Comments must be received by January 10, 2019. Our focus is on outpatient facility coding and reimbursement, but facility coders and pro-fee coders need to be aware that the facility is not the only entity that can submit claims for services performed in facilities. Outpatient Hospital Reimbursement Emergency Room Services OHCA recently transitioned some codes currently paid under a different methodology to the APC payment methodology and the first codes to be transitioned were the emergency department facility fees. The ICD-10-CM code set is used in all clinical settings (including outpatient facilities, inpatient facilities, and physician offices) to capture diagnoses and the reason for the visit. (d) Outpatient hospital imaging. Charges that are entered into the system are assigned a revenue code associated to the hospital’s chargemaster and captured on the UB-04 claim form. Moreover, Federal law under Section 1903 (i) of the Social Security Act limits Medicaid reimbursement for clinical diagnostic laboratory services to the amount of the Medicare fee schedule for the services on a per test basis. Outpatient hospital non-emergency surgery is reimbursed in accordance with the methodology for ambulatory surgical centers as described in §355.8121 of this subchapter (relating to Reimbursement). The interpreting physician bills the professional component of the same radiology procedure by appending modifier 26 Professional component. Healthcare Reimbursement Methodologies: Medicare Prospective Payment System Unit outcome addressed in this Assignment: Define the key elements of prospective payment and the impact on the health care at a facility. The type of code to use for a specific service is another area that sometimes differentiates professional fee coding from facility coding. Not paid under OPPS. o The goal is to align HMO and FFS reimbursement policy for outpatient services. Value-Based Reimbursement. <]>>
The HCPCS Level II code set includes a section specific to outpatient hospital reporting. This is similar to the method used to calculate the reimbursement under the MPFS. There are many outpatient hospital departments that have specific guidelines on how to code and bill for certain services, such as intravenous (IV) injection and infusion, chemotherapy, and radiation therapy, all of which require in-depth knowledge usually obtained by a certified coder. There is no separate payment for the item. o There will be no change to the existing Access Payment Reimbursement Methodology for HMOs. UHI Ch 9: CMS Reimbursement Methodologies. Under the RBRVS methodology, providers are reimbursed based on CMS’ Medicare Physician Fee Schedule (MPFS), which is a complete list of procedures and fees with indicators that determine how the procedure may be reimbursed. For the most part, the provision of healthcare services takes place in a unique way. Found inside – Page 439The growth of outpatient payments for services provided to Medicare beneficiaries has been influenced by several significant ... based reimbursement methodologies for ambulatory surgery, home care, and general outpatient service areas. To avoid incorrect coding and reduce the likelihood of denied or rejected claims and inaccurate reimbursement, the best practice is to refer only to the guideline sections (including general sections) that apply to the healthcare setting where the encounter is being coded. This amendment will substantially revise the methodology for The exclusion list found in Addendum EE includes CPT® unlisted codes, surgical procedures Medicare does not recognize for payment, and those that CMS medical advisors determined pose a significant risk to beneficiary safety or expect to require an overnight stay. Key Difference Between Inpatient and Outpatient Coding Guidelines for Uncertain Diagnosis. Found inside – Page 187management must be aware of the change to the ICD-10-CM methodology because of its impact on the revenue cycle. ... Unlike inpatient reimbursement, the outpatient setting is significantly different due to the lack of time spent in a ... Many commercial payers have also adopted the OPPS methodology. Rates were established using the hospital's most recent tentative cost report settlement. Medicare created C codes for use by Outpatient Prospective Payment System (OPPS) hospitals. This website is not compatible with Internet Explorer. hތR�n�0��+�HB�-�(۴�B��n$=�S������L�����8����"`D��q
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Guidelines in this section do not apply to inpatient hospital services. Overview of Current Outpatient Hospital Reimbursement System Versus Enhanced Ambulatory Patient Grouping System o Current outpatient hospital reimbursement system is an all-inclusive payment methodology. MSBCBS Customization of APC Based OPPS NOTE: The basic issue of MSBCBS covered services determination has not been affected. Medicare: Discrepancy in Hospital Outpatient Prospective Payment System Methodology Leads to Inaccurate Beneficiary Copayments and Medicate Payments Ambulatory Payment Classification (APC) reimbursement methodology for outpatient procedures. Facility coders should be sure to use the correct, approved modifiers to prevent billing issues, checking payer policies, as well. A clean claim is electronically submitted to the payer for claims adjudication and reimbursement. Hospital Outpatient Prospective Payment Reimbursement Methodology/ASC. 0000001537 00000 n
), which is separate from the professional fee. (d) Outpatient hospital imaging. Let's review a major difference between inpatient and outpatient coding guidelines specific to coding an uncertain diagnosis: Outpatient: ICD-10-CM Official Guidelines, Section IV.H, Uncertain diagnosis, is specific to outpatient coding: “Do not code diagnoses documented as ‘probable,’ ‘suspected,’ ‘questionable,’ ‘rule out,’ ‘compatible with,’ ‘consistent with,’ or ‘working diagnosis’ or other similar terms indicating uncertainty. Appendix D describes Medicare's reimbursement methodologies for the service areas with a comparable rate used in this study. Promote use of Best Practices for billing Outpatient Facility & Hospital Billing Methods to maximize office profits, and speed up claim processing techniques. PUBLISHER'S NOTE: The secretary of state The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following actions regarding reimbursement methodology for covered outpatient drugs (COD) purchased through the pharmacy program under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid). Retrospective reimbursement and prospective reimbursement are the major methods for outpatient reimbursement. This section describes the methodology for reimbursing all acute care, psychiatric, rehabilitation, long-term care, and critical access hospitals located in the State of Wisconsin for outpatient hospital services provided in 2 of 16 Hospital Outpatient Billing and Reimbursement Guide Version 10.01 January 2010 Provider Version • Lines that are not determined to receive APC payments are designated to be paid under alternative methods. Out-of-State Outpatient Hospital Service Reimbursement. Prospective Outpatient Drugs Reimbursement Methodology" in the subject line. No inflation, inflationary factor, or any other automatic increase is included in any reimbursement for outpatient hospital services. The CPT® code set, developed and maintained by the American Medical Association (AMA), is used to capture medical services and procedures performed in the outpatient hospital setting or to capture pro-fee services, meaning the work of the physician or other qualified healthcare provider. To ensure complete and accurate coding of services, outpatient hospital facility coders must understand and reference outpatient hospital coding guidelines and payer-specific guidelines. Additional changes have been made since then. (c) Outpatient hospital surgery. To accurately assign medical codes, the outpatient facility coder must have a good understanding of official coding guidelines, such as the ICD-10-CM Official Guidelines for Coding and Reporting, AMA CPT® guidelines for medical services and procedures, and the National Correct Coding Initiative (NCCI) edits and policy manual. §355.8061.Outpatient Hospital Reimbursement. Hospital-based ASCs use the UB-04 form, while freestanding ASCs typically use the CMS-1500 claim form. For example, Medicare outpatient reimbursement for children's hospitals is augmented by "traditional corridor Fee-for-Service. After January 1, 2009 claims filed with revenue code 45X without an appropriate CPT will no longer pay an emergency department facility fee. It’s worth noting that this outpatient scenario is similar to how the physician would bill for a service they performed in an inpatient setting. Therefore, OHCA modified the emergency department reimbursement methodology facility fee effective January 1, 2009 to more closely follow Medicare’s APC payment methodology. Reimbursement is solely based upon the methodology described below. Privacy Policy | Terms & Conditions | Contact Us. The electronic version of the CMS-1500 is called the 837P (Professional), the ANSI ASC X12N 837P, or the American National Standards Institute Accredited Standards Committee X12N 837P (Professional) Version 5010A1. The resources typically include the room, nursing staff, supplies, medications, and other items and staffing the facility bears the cost for. Found inside – Page 339the payments are totaled to provide reimbursement to the hospital for the encounter. ... ambulatory patient groups (APGs) as a new payment methodology for most Medicaid outpatient services (e.g., outpatient clinic, ambulatory surgery, ... 0000002961 00000 n
(c) Outpatient hospital surgery. If you are experiencing difficulties, please try a different Internet browser (Chrome, Firefox, Edge or Safari). 0
Procedures or services that require the manual coding of ICD-10-CM, CPT. 2. The 2021 OPPS and ASC payment system final rule included Medicare’s decision to eliminate the Inpatient Only (IPO) list over a three-year transition period, phasing out the list by 2024. Coding for outpatient services affects reimbursement because the facility bills CPT® code(s) for the surgery on the UB-04 claim form to be reimbursed for the resources (room cost, nursing staff, etc.) In fact, according to the United States Ambulatory Surgery Center Market Report 2019, from 2015-2022, the proportion of outpatient cases performed in ASCs . 0000000016 00000 n
9 - CMS Reimbursement Methodologies. 3: . Typically, the more complex medical services and procedures are soft-coded. According to outpatient-focused Section IV.H, the encounter should be coded based on the signs or symptoms, which in this case are chest pain and SOB. Outpatient facility managers and coders should be certain they are referencing the correct, current data files when billing for an ASC. On Aug. 1, 2000, CMS implemented OPPS. Therefore, each E/M service performed is coded using the appropriate CPT® code(s) to capture the professional work (pro-fee). Section 3. The business office plays a vital role in this process by ensuring that a clean claim is submitted to the payer. Shared Savings. In the past, hospitals were paid using an all-inclusive bundled rate that included laboratory, radiology, and all other ancillary services. For healthcare financial staff, some cycles are so common they are taken for granted - day and night, seasonal changes, month-end close, year-end reporting. The APC method pays for outpatient hospital services, The patient encounter process then flows through the typical outpatient facility channels before a claim is generated and processed for payment by the business office. 0000002924 00000 n
Found inside – Page 375NOTE: New York State will phase in ambulatory patient groups (APGs) as a new payment methodology for most Medicaid outpatient services (e.g., outpatient clinic, ambulatory surgery, and emergency department services). established predetermined rates based on pt category or type of facility (w/annual incr. The reimbursement methodology for home The OPPS Status Indicators can be found in the OPPS Addendum D1 file on the CMS website. For instance, Section IV, Diagnostic Coding and Reporting Guidelines for Outpatient Services, is relevant to coding and reporting hospital-based outpatient services and provider-based office visits. To account for geographic differences, CMS adjusts the labor portion of the conversion factor (a number used in the calculation) based on the hospital wage index, which is essentially the personnel/staff earnings. The HCPCS Level II code set is maintained by the Centers for Medicare & Medicaid Services (CMS). As an example, suppose a patient with Medicare presents for a same-day surgery in an outpatient hospital setting. Patients . Figure 1. In the outpatient hospital setting, charges for resources used, medical services, and procedures that do not require the skill set of a coding professional typically are hard-coded directly from the hospital’s Charge Description Master (CDM or chargemaster) and captured on the hospital’s UB-04 claim form. However, the facility coders also would submit claims to bring in reimbursement for the facility resources used (such as the room cost, nursing personnel, drugs, supplies, etc. ꜚ�3E�CTodn�SY���M�kx����D7�2&۰ٕ��\��E˘�ZT�D��1A!�sU�ăj��zE�27_�m���aaä�Q�@�27y�&�� mg Which of the following reimbursement methodologies is not utilized in the Outpatient Hospital Services Payment System? Hospital Reimbursement Guide Version 1 July 2018 PURPOSE This Facility Reimbursement Manual shall define reimbursement between Highmark WV and Provider for Provider's provision of Covered Services, both inpatient and outpatient services, to Members during the . DRG system adapted for use by third-party payers to reimburse hospitals for inpatient care provided to non-Medicare beneficiaries (e.g., BlueCross BlueShield, commercial health plans, TRICARE); DRG assignment is based on intensity of resources. HIM 2223 Test Questions Chapter 7 1. -Does not adjust payment based upon acuity or complexity of case. 3. The facility captures the charges and codes, typically on the UB-04 claim form, and sends the claim to the payer for reimbursement. The CY2022 OPPS/ASC NPRM Table 35 - Proposed Additions to the Inpatient Only (IPO) List for CY 2022 (ZIP), is reposted here for ease of use and is included in the proposed rule. First, often only a few providers of a particular service exist in a given . The Outpatient Prospective Payment System (OPPS) is a Medicare reimbursement methodology used to determine fees for Part B outpatient services. OHCA recently transitioned some codes currently paid under a different methodology to the APC payment methodology and the first codes to be transitioned were the emergency department facility fees. CODING corner B (c o n ti u ed x pag ) 22 HbMA bIllInG • MAy.jUne.2010 same day) and electrophysiology ablation procedures (code 93619 or 93620 on the same day as 93650, 93651, or 93652). Providers will bill the revenue code 45X with the appropriate CPT code and the claim will price off the APC table. For example, status indicator “N” shown in Table 1 indicates the item is packaged into the APC rate, which means the payment is included in another payable service. tit. Section 4. Outpatient hearing screening and diagnostic testing services for children are provided by physicians and are reimbursed in accordance with the reimbursement methodology for physician services at 1 TAC §355.8085, 1 TAC §355.8141, and 1 TAC §355.8441. Outpatient hospital non-emergency surgery is reimbursed in accordance with the methodology for ambulatory surgical centers as described in § 355.8121 of this subchapter (relating to Reimbursement). After a full assessment and work-up, a final diagnosis of rule-out acute myocardial infarction (AMI) is documented. The Hospital Outpatient Prospective Payment System booklet is now available in another format Author: CMS Subject: The Hospital Outpatient Prospective Payment System booklet is now available in another format Created Date: 4/21/2021 1:04:09 PM Code Regs. 4100 Introduction. Call 877-290-0440 or have a career counselor call you. Department of Health and Human Resources Change Log Chapter 600: Reimbursement Methodologies Page 1 Revised January 1, 2006 September 1, 2003 CHAPTER 600-REIMBURSEMENT METHODOLOGIES CHANGE LOG Replace Title Change Date Effective Date Section 615 CPT/HCPCS National Level Code Updates 12/16/05 01/01/06 A list of covered procedures that are eligible for reimbursement are found in the Addenda AA and BB data files. Clinical assessment and documentation of services provided, order of relevant diagnostic and laboratory tests, and documentation of the final diagnosis for that visit is completed. area. These instructions also apply to the Children's Health Insurance Plan (CHIP). 107 0 obj
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Each year, the Office of the Federal Register (OFR) releases a Notice of Proposed Rulemaking (NPRM) to announce any planned changes to the OPPS. The CY2022 OPPS/ASC Notice of Proposed Rulemaking (NPRM) (CMS-1753-P) including related links to the CY2022 NPRM OPPS Payment Rate addenda are now available.. Ch. Paid at reasonable cost; not subject to deductible or coinsurance. Found inside – Page 10-812 Drugs and biologic products covered under Part B are reimbursed in one of two ways . ... 14 To lessen the impact of switching from a reasonable cost reimbursement methodology for hospital outpatient services to the PPS , for at least ... These are often referred to as code sets. As such, a thorough understanding of outpatient hospital reimbursement can only benefit a hospital's bot-tom line, now and in the future. trailer
Note that Medicare has identified certain other facilities, such as critical access hospitals, that may use C codes at their discretion. This change means that many new procedures will be eligible for payment in an outpatient setting, proving that staying up to date on rule changes is essential to successful outpatient facility coding and reimbursement. It is important for medical coders and billers to understand the billing requirements for both a hospital-based ASC and an independent freestanding ASC. Found inside – Page 529to various prospectively set payment methodologies . Further , with hospitals aggressively developing outpatient services and shifting costs as a means to offset declining inpatient income , other payers are focusing on the conversion ... endstream
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Outpatient hospital non-emergency surgery is reimbursed in accordance with the methodology for ambulatory surgical centers as described in §355.8121 of this subchapter (relating to Reimbursement). o There will be minimal use of grouper options to lessen provider impact. Payment for facility services will be made to hospital-based and independent ambulatory surgery centers for certain outpatient surgical procedures. 0000003678 00000 n
One big difference is that the main procedure coding system used for inpatient claims is the ICD-10-PCS code set rather than CPT®. REIMBURSEMENT METHODOLOGIES. (Medicare, for instance, no longer accepts the consult codes, and providers and coders should check with their individual payers to determine the appropriate codes for billing consultations.). HITT-2335 Fall 2011 08/22/2011 - 12/11/2011 The state's proposed methodology is based on Medicare fee schedules with no accommodation for the safeguards and special payment provisions Medicare employs for children's hospitals to ensure their payments are fair and adequate. Found inside – Page 1213The outpatient payment percentage for the fourth and fifth year in which the hospital operates will be based on the ... PROPOSED RULE 13 CSR 70-15.160 Prospective Outpatient Hospital Services Reimbursement Methodology ( 3 ) Closed ... processed under the Grouper will continue to be subject to PEIA reimbursement methodologies and Acordia's claim edits, including CodeReview.
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