Certified Inpatient Coding (CIC) Practice Exam

Which of the following is NOT a function of the OPPS?

1. Separately paying for all ancillary services

2. Bundling outpatient services into a single rate

3. Providing integrated payment for related services

4. Grouping services with similar clinical characteristics

The correct answer is: Separately paying for all ancillary services

The correct choice highlights that the Outpatient Prospective Payment System (OPPS) does not separately pay for all ancillary services. Instead, OPPS is designed to consolidate payment for outpatient services provided to patients, meaning that many ancillary services are bundled together and not reimbursed separately. The OPPS structure is aimed at establishing more efficient payment methodologies where various services—like the primary service and related ancillary services—are combined into a single payment rate. This approach helps in simplifying billing and controlling healthcare costs while ensuring that healthcare providers are incentivized to deliver a variety of related services within an outpatient setting. The other options are key functions of OPPS: - Bundling outpatient services into a single rate minimizes administrative costs and encourages providers to manage resources effectively. - Providing integrated payment for related services promotes coordinated care, thus enhancing the quality of patient service. - Grouping services with similar clinical characteristics allows for a standardization of payment based on the nature and complexity of care provided, facilitating better financial predictability. Overall, the OPPS aims to create a more efficient and integrated payment system for outpatient care, which is reflected in the functions it encompasses, but not in separately paying for each ancillary service.