Certified Inpatient Coding (CIC) Practice Exam

Under the OPPS, which term refers to an item that will not receive separate payment because it is considered an integral part of another service?

1. Combining

2. Packaging/Bundling

3. Status Indicator

4. Non-covered service

The correct answer is: Packaging/Bundling

The term that indicates an item not receiving separate payment because it is regarded as an integral part of another service is packaging or bundling. In the context of the Outpatient Prospective Payment System (OPPS), services and items that are clinically related may be grouped together, and payment is made for the entire package rather than for each individual component. This approach is designed to streamline billing and ensure that providers are compensated fairly for comprehensive care, rather than for each individual service rendered. Bundling promotes efficiency in healthcare delivery by encouraging providers to deliver more integrated services, which can lead to better patient outcomes. It also helps to minimize unnecessary procedures and assessments that might arise if each component was billed separately. This concept also serves to simplify the reimbursement process, aligning it with the overall goal of cost containment in the healthcare system. Options like combining, status indicator, and non-covered service do not encapsulate this specific concept. Combining suggests a different aspect of integration that doesn't directly refer to payment methodologies. Status indicators are used to define payment rules and impact how services are billed, while non-covered services refer to items that are not eligible for reimbursement at all, rather than those bundled with covered services.