Ambulatory Care Services and the Prospective Payment System - Ambulatory Care Services and the Prospective Payment System - Brief Article

Healthcare Financial Management, April, 2001 by John P. de Koff

Edited by Norbert Goldfield and William P. Kelly Aspen Publishers, Inc., Gaithersburg, MD, 1999 292 pages, $69

Ambulatory Care Services and the Prospective Payment System is a collection of contributed chapters, edited by Norbert Goldfield and William Kelly, that is intended as an introduction to Medicare's outpatient prospective payment system (PPS). One might assume that because the outpatient PPS has been in force for some time, the book will be of little use now. On the contrary the book remains a useful guide to making the most of the new payment system.

The book is divided into two major parts. Chapters 2 through 5 provide practical information that healthcare organizations can use to ensure they receive the full payment to which they are entitled under the Medicare program. Chapters 6 through 15 provide background material explaining how the outpatient PPS evolved and the underlying rationale for the system.

Healthcare financial managers will find the first part to be the most useful. Chapter 2 gives an overview of the outpatient PPS. Particularly helpful is the authors' discussion of how hospitals can use the coinsurance changes under the PPS as a marketing tool to encourage Medicare beneficiaries to use their facilities.

Chapter 3 discusses the preparation needed to implement the outpatient PPS. Although this implementation largely has taken place, healthcare financial managers can use the information provided to see whether their current processes could be improved. The authors include a list of projects that finance and health information management departments and business offices should undertake to secure the optimum payment. An appendix to this chapter provides useful management reports.

Chapter 4 offers excellent, comprehensive information on coding for the outpatient PPS, including discussions of modifiers, unlisted codes, and the Correct Coding Initiative. Chapter 5 reviews ways that outpatient PPS implementation can improve data collection for outpatient services.

Ambulatory Care Services and the Prospective Payment System is far from out of date. It is useful for improving both an organization's compliance with the outpatient PPS regulations and its bottom line.