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OPPS – a payment system of reimbursement for hospital outpatient services

By Saurabh Pandey Subscribe to RSS | December 13th 2011 | Views:

It has become a must for the health care service providers to undergo annual price reviews. The main reasons for these types of changes are the increasing competition and the transformation into consumer driven healthcare environment. The changes in legislation are also one of the reasons why hospitals are opting to analyze hospital data for benchmarking analyses.

HPS has been helping health care service providers in this, since the year 1993. It provides the custom hospital data after a detailed analysis through which clients can choose a particular hospital for pricing comparison at the HCPCS or MS-DRG levels.

HPS can provide the crucial data like outpatient data, inpatient data, inpatient service line pricing, department level pricing, hospital room rates and hospital financial data, derived from Medicare cost reports within just 48 hours. The researchers at HPS are able to analyze the inpatient record of any Medicare patient who is admitted in the hospital for the treatment of any ICD diagnosis after consulting the MEDPAR file.

The MEDPAR which is short for Medicare provider analysis and review can be used to analyze the patterns and outcomes of a particular hospital’s inpatient care by the length of stay of patients, their complications and prices. The MEDPAR records also contain the final action claims data in which all adjustments have been resolved.

Consumers are becoming more and more knowledgeable to what they are paying to the hospitals that is why it becomes important for every medical service provider whether it is a private hospital or nursing homes, to have the information such as inpatient pricing and outpatient pricing. Based on the reports provided by HPS, consumers can easily do accurate hospital price comparisons. This comparative study also helps them in choosing the right medical service provider for them.

The consumers with the help of valuable hospital data provided by us come in a position to do hospital price comparisons along with hospital benchmarking. This comparison enables the healthcare medical system to become more cost effective and efficient. Not only this, consumers can also make accurate hospital price comparisons with the help of this strong medical data.

OPPS is short for Outpatient Prospective Payment System. OPPS has proved to be tremendously useful for patients as well as Centers for Medicare and Medicaid Service Providers which is a database made by CMS for reimbursement of hospitals that provide outpatient services.

The OPPS was implemented on August 1, 2000 and since then it has been made compulsory for every CMS hospital to have a Hospital Outpatient Prospective Payment System (OPPS). With the help of this system the beneficiary co-payments have been reduced to a large extent.

Saurabh Pandey - About Author:
Rick Louie leads Hospital Pricing Specialists, having over 20 years experience in providing hospital benchmark data to providers and consulting firms. Mr. Louie is a graduate of Harvard University, with a degree in Economics. Prior to joining HPS, Mr. Louie was the Vice President of Business Intelligence with HeathDataInsights, the CMS RAC auditor for Region D. Also, Mr. Louie was a management consultant at Deloitte Consulting and American Practice Management.

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