Beyond pricing under the hospital OPPS methodology, BRS supports payment policies for many Hospital Outpatient services, including:
- Pricing under the Ambulatory Payment Classification (APC) methodology
- Pricing under the appropriate fee schedule (RBRVS, Lab, DME) for APC status A codes
- Hospitals for the entire country selectable by National Provider Identifier (NPI), 6-character CMS Certification Number (CCN) or name
- Hospital specific wage index adjustment accounting for facility reclassification and out-migration adjustments
- Outpatient Code Editor (OCE) with all active edits, including National Correct Coding Initiative (NCCI) edits, procedure/device edits, blood edits, edits for conflicts between age or sex and diagnosis and many others
- Outlier adjustment, line item based and specific to the facility’s cost-to-charge (CCR) ratio
- Special 7.1 percent adjustment for rural (or reclassified as rural) Sole Community Hospitals (SCHs) and Essential Access Community Hospitals (EACHs)
- Medically Unlikely Edits (MUEs)
- Bilateral procedure logic (modifier 50)
- LDR prostate brachytherapy and Electrophysiology/ablation composite APC assignment criteria (APC groups 8000 and 8001)
- Multiple Imaging composite assignment rules & criteria (APC groups 8004 through 8008)
- STVX-packaging and T-packaging
- Observation criteria and Extended Assessment & Management composite logic (APC groups 8002 and 8003)
- Direct Admission Logic
- Lab NCDs
- Critical Care packaging
- Multiple procedure discounts
- Terminated procedure logic (modifiers 52 or 73)
- Rules for medical and procedure visits on the same day and for multiple medical visits on same day
- Partial Hospitalization Logic
- Mental Health Logic
- Device credits (modifiers FB and FC)
- Lab panel pricing based on ATP rates (July 2009)
- Always Therapy Multiple Procedure Payment Reductions (MPPR)