Phlebotomy Essentials
6th Edition
ISBN:9781451194524
Author:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Publisher:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Chapter1: Phlebotomy: Past And Present And The Healthcare Setting
Section: Chapter Questions
Problem 1SRQ
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Question
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![You attended an in-service education program about the **outpatient prospective payment system (OPPS)** where you learned that certain Medicare Part B services are paid according to **ambulatory payment classifications (APCs)**, which group services according to similar clinical characteristics and in terms of resources required. A payment rate is established for each APC and, depending on services provided, hospitals may be paid for more than one APC for a patient encounter.
As part of the in-service, you are provided with the following information and required to answer each question by applying the formula to calculate APC payments.
**Outpatient Prospective Payment System (OPPS) Formula**
(APC Weight × Conversion Factor × Wage Index) + Add-On Payments = Payment
_NOTE: When a patient undergoes multiple procedures and services on the same day, multiple APCs are generated and payments are added together. APC software automatically discounts multiple APC payments when appropriate (e.g., bilateral procedure)._
- **Conversion Factor** = $80.79
- **Wage Index** = 0.9445
| HCPCS Code | Description | APC | APC Weight |
|------------|------------------------------------------------------|-----|------------|
| 66984 | Cataract procedure with intraocular lens implant | 246 | 24.56 |
| 71046 | Chest x-ray, 2 views | 260 | 1.56 |
| 78740 | Ureteral reflux study | 292 | 3.94 |
**Question:**
What is the total APC payment for HCPCS codes 66984, 71046, and 78740? Round the answer to two decimal points. Explain.
---
**Explanation and Calculation:**
1. **Calculate the payment for each HCPCS code:**
- For 66984:
\[
\text{Payment} = 24.56 \times 80.79 \times 0.9445 = 1874.81
\]
- For 71046:
\[
\text{Payment} = 1.56 \times 80.79 \times 0.9445 = 118.55
\]
- For 78740:
\[
\text{Payment} = 3.94 \times 80.79 \times 0.9445 = 300.24
\]
2. **Add the payments](/v2/_next/image?url=https%3A%2F%2Fcontent.bartleby.com%2Fqna-images%2Fquestion%2F2df7c921-786f-4ed7-b57d-3e75f594a576%2F8535cf5f-04d8-4cfa-8a8c-f190b5a83229%2Fzyo4nm9_processed.png&w=3840&q=75)
Transcribed Image Text:You attended an in-service education program about the **outpatient prospective payment system (OPPS)** where you learned that certain Medicare Part B services are paid according to **ambulatory payment classifications (APCs)**, which group services according to similar clinical characteristics and in terms of resources required. A payment rate is established for each APC and, depending on services provided, hospitals may be paid for more than one APC for a patient encounter.
As part of the in-service, you are provided with the following information and required to answer each question by applying the formula to calculate APC payments.
**Outpatient Prospective Payment System (OPPS) Formula**
(APC Weight × Conversion Factor × Wage Index) + Add-On Payments = Payment
_NOTE: When a patient undergoes multiple procedures and services on the same day, multiple APCs are generated and payments are added together. APC software automatically discounts multiple APC payments when appropriate (e.g., bilateral procedure)._
- **Conversion Factor** = $80.79
- **Wage Index** = 0.9445
| HCPCS Code | Description | APC | APC Weight |
|------------|------------------------------------------------------|-----|------------|
| 66984 | Cataract procedure with intraocular lens implant | 246 | 24.56 |
| 71046 | Chest x-ray, 2 views | 260 | 1.56 |
| 78740 | Ureteral reflux study | 292 | 3.94 |
**Question:**
What is the total APC payment for HCPCS codes 66984, 71046, and 78740? Round the answer to two decimal points. Explain.
---
**Explanation and Calculation:**
1. **Calculate the payment for each HCPCS code:**
- For 66984:
\[
\text{Payment} = 24.56 \times 80.79 \times 0.9445 = 1874.81
\]
- For 71046:
\[
\text{Payment} = 1.56 \times 80.79 \times 0.9445 = 118.55
\]
- For 78740:
\[
\text{Payment} = 3.94 \times 80.79 \times 0.9445 = 300.24
\]
2. **Add the payments
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