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What is the OPPS Pricer and how will it be used to calculate the reimbursement for my hospital?

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What is the OPPS Pricer and how will it be used to calculate the reimbursement for my hospital?

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The OPPS Pricer is a software program that was developed by 3M. It will utilize site-of-service wage indices in the adjustment of national payment amounts for Ambulatory Payment Code (APC) Healthcare Common Procedure Coding System (HCPCS) Level I and II codes (e.g., a HCPCS code designated status indicator S, T, V, or X) reported on a hospital outpatient claim. The Pricer also will apply discounting for multiple surgical procedures performed during a single operative session and outlier payments for extraordinarily expensive cases. Appropriate deductible, cost-sharing/copayment amounts and catastrophic cap limitations will be not be calculated by the Pricer. It will be applied by TriWest’s claims processing system and will be based on the eligibility status of the TRICARE beneficiary at the time the outpatient services were rendered. For more information, contact a 3M sales representative at 800-367-2447, or visit www.3Mhis.com.

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