Comparison of Coding and Billing Practices Among Selected Small Rural and Urban Hospital Outpatient Departments

The Centers for Medicare and Medicaid Services (CMS) estimated the new outpatient prospective payment system (OPPS) was likely to have a greater detrimental impact on Medicare revenue for small rural hospitals than on any other type of hospital. However, CMS suggested the negative impacts projected for small rural hospitals were at least partially attributable to undercoding and coding variations in the data, and that once small rural hospitals began coding appropriately, the negative effects would likely diminish. This project explores whether undercoding or not billing for selected Medicare outpatient services appears to be more of an issue for small rural hospitals than for urban hospitals and identifies other issues that have arisen in the implementation of OPPS that may be of particular concern to the small rural hospital. Data will be gathered qualitatively through a series of interviews with key informants from selected small rural and urban hospitals.

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