Certified Professional Coder (CPC) Practice Test

The primary focus of the Outpatient Prospective Payment System (OPPS) is to determine payment rates for outpatient services. This system is specifically designed to reimburse healthcare providers for services rendered to patients who are not admitted to a hospital. Under OPPS, the Centers for Medicare & Medicaid Services (CMS) establishes a fixed payment rate for outpatient procedures and services based on predetermined rates. This approach allows for predictable reimbursement and supports the efficient management of healthcare resources within outpatient settings. By standardizing payment rates, OPPS encourages the provision of cost-effective care and enhances the accountability of outpatient services. The other options relate to aspects of healthcare governance but do not pertain to the core purpose of OPPS. For instance, reimbursement for inpatient services is handled separately through different systems, and long-term care facilities have distinct regulations and payment mechanisms unrelated to outpatient care. Similarly, health insurance premium regulation falls outside the remit of OPPS, focusing instead on the administration of insurance rather than the reimbursement of specific outpatient services.