What does the Hospital Outpatient Prospective Payment System (HOPPS) edits apply to?

The Hospital Outpatient Prospective Payment System (HOPPS) edits specifically apply to various types of billing related to outpatient services provided by hospitals and some other facilities. This includes surgical procedures and outpatient visits that are covered under the HOPPS guidelines.

The focus of HOPPS is on how hospitals are reimbursed for outpatient care, ensuring that the services provided align with established coding standards and appropriate payment rates. Thus, it directly pertains to the types of bills generated from hospitals as well as skilled nursing facilities that deliver outpatient services, emphasizing the correct coding and billing practices needed for compliance.

Understanding that HOPPS is primarily concerned with outpatient procedures helps clarify that options related to inpatient services or emergency room specifics are outside its scope, as they are governed by different regulations and payment methodologies. Similarly, while federal health policy regulations are important, they are not what HOPPS edits specifically target.