Certified Outpatient Coder (COC) Practice Exam

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The primary goal of implementing OPPS was to achieve what?

Create a fee-for-service reimbursement model
Create a prospective payment system for outpatient services
Reduce overall costs to patients
Streamline inpatient admission processes

The correct answer is: Create a prospective payment system for outpatient services

The primary goal of implementing the Outpatient Prospective Payment System (OPPS) was to create a prospective payment system for outpatient services. This system was established to standardize payments for outpatient services across healthcare facilities, thereby promoting consistency and predictability in reimbursement. By using a prospective payment model, healthcare providers receive a predetermined payment amount for each service based on diagnosis-related groups (DRGs) rather than being reimbursed based on the actual costs incurred. This approach is designed to encourage efficient service delivery and reduce unnecessary services while ensuring that patients have access to outpatient care. The implementation of OPPS also aimed to improve the financial sustainability of outpatient services in a complex healthcare environment.