Medicare's outpatient code editor is key to APC payments

Since implementation of the outpatient prospective payment system (PPS) in August 2000, HCFA has used an inadequate communication process to inform providers about billing and coding requirements. Numerous program memorandums have been issued to communicate changes to the outpatient PPS and even to correct information that was provided in previous program memorandums. Providers need to monitor changes in outpatient PPS policy by reading the program memorandums posted on HCFA's Web site (www.hcfa.org) and through reviewing other informal communications posted to the HCFA Web site. In addition, the outpatient code editor (OCE) contains information about quarterly APC classification updates. In fact, the OCE is the only source of this information in many cases. Because the outpatient PPS differs from any other PPS implemented by HCFA, providers should ensure that they have all the current information they need to comply with the system's billing and coding requirements.