Others titles

  • Integrated Outpatient Quarterly Release Files Version 20.1
  • Revenue Codes Data for IOCE Quarterly Release Files

Keywords

  • Valid Revenue Codes for IOCE
  • IOCE Quarterly Release Files V 20.1
  • Integrated Outpatient Code Editor
  • Outpatient Prospective Payment System
  • OCE Claim Record
  • Ambulatory Payment Classification (APC)
  • CMS APC
  • Valid Modifiers for NCCI

Valid Revenue Codes for IOCE Quarterly Release Files

This dataset contains information about ‘integrated’ Outpatient Code Editor (I/OCE) program processes claims for all outpatient institutional providers including hospitals that are subject to the Outpatient Prospective Payment System (OPPS) as well as hospitals that are NOT (Non-OPPS). This dataset contains the Valid Revenue codes for January, 2016.

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Description

Prior to OPPS, the software focused solely on editing claims without specifying any action to take when an edit occurred. It also did not compute any information for payment purposes. The OPPS functionality of the Integrated Outpatient Code Editor (I/OCE) software was developed for the implementation of the Medicare outpatient prospective payment system mandated by the 1997 Balanced Budget Act. CMS released the proposed OPPS rules using the Ambulatory Payment Classification (APC) system in the September 8, 1998 Federal Register. Final regulations were published in the April 7, 2000 Federal Register and the system became effective for Medicare on August 1, 2000.The APC-based OPPS developed by CMS is the outpatient equivalent of the inpatient, DRG-based PPS. The APC system establishes groups of covered services so that the services within each group are comparable clinically and with respect to the use of resources.

Claim will be identified as ‘OPPS’ or ‘Non-OPPS’ by passing a flag to the Outpatient Code Editor (OCE) in the claim record, 1=OPPS, 2=Non-OPPS; a blank, zero, or any other value is defaults to 1. These edits are updated quarterly and changes are communicated through Program Memorandum Transmittals. The dataset contains the Valid Revenue codes for January, 2016. Revenue codes are 4-digit numbers that are used on hospital bills to tell the insurance companies either where the patient was when they received treatment, or what type of item a patient might have received as a patient. A medical claim will not be paid if this is missing from a bill.

The OCE not only identifies individual errors but also indicates what actions should be taken and the reasons why these actions are necessary. In order to accommodate this functionality, the OCE is structured to return lists of edit numbers. This structure facilitates the linkage between the actions being taken, the reasons for the actions and the information on the claim (e.g., a specific diagnosis) that caused the action. In general, the OCE performs all functions that require specific reference to HCPCS codes, HCPCS modifiers and ICD-9-CM diagnosis codes. Since these coding systems are complex and annually updated, the centralization of the direct reference to these codes and modifiers in a single program will reduce effort and reduce the chance of inconsistent processing. Current Version is 62 and effective date is 2016-01-01.

About this Dataset

Data Info

Date Created

2016-01-11

Last Modified

2019-10-01

Version

2019-10-01

Update Frequency

Quarterly

Temporal Coverage

2018-07 to 2019-10

Spatial Coverage

United States

Source

John Snow Labs; Centers for Medicare and Medicaid Services;

Source License URL

Source License Requirements

NA

Source Citation

NA

Keywords

Valid Revenue Codes for IOCE, IOCE Quarterly Release Files V 20.1, Integrated Outpatient Code Editor, Outpatient Prospective Payment System, OCE Claim Record, Ambulatory Payment Classification (APC), CMS APC, Valid Modifiers for NCCI

Other Titles

Integrated Outpatient Quarterly Release Files Version 20.1, Revenue Codes Data for IOCE Quarterly Release Files

Data Fields

Name Description Type Constraints
Revenue_CodeValid revenue center codestringlevel : Nominalrequired : 1
Is_Blank_HCPCS_NStatus indicator (N) for revenue center, if no HCPCS presentboolean-
Is_Blank_HCPCS_EStatus indicator (E) for revenue center, if no HCPCS presentboolean-
Is_Blank_HCPCS_BStatus indicator (B) for revenue center, if no HCPCS presentboolean-
Is_Blank_HCPCS_FStatus indicator (F) for revenue center, if no HCPCS presentboolean-
Is_Bundled_BiologicalIndicate that claim is submitted with a procedure (HCPCS) identified as being bundled into the cost of a biological or aboolean-
VersionCurrent Version 77 = October, 2019integerlevel : Nominal
Start_DateEffective date of “VER”date-

Data Preview

Revenue CodeDescriptionIs Bundled Biological
1Total ChargeFalse
22Health Insurance - Prospective Payment System (HIPPS) - Skilled Nursing Facility PPSFalse
23Health Insurance - Prospective Payment System (HIPPS) - Home Health PPSFalse
24Health Insurance - Prospective Payment System (HIPPS)/inpatient Rehab Facility PPSFalse
100All Inclusive Rate - All-inclusive Room and Board Plus AncillaryFalse
101All Inclusive Rate - All-inclusive Room and BoardFalse
110Room & Board - Private (One Bed) - General ClassificationFalse
111Room & Board - Private (One Bed) - Medical/Surgical/GynFalse
112Room & Board - Private (One Bed) - Obstetrics (OB)False
113Room & Board - Private (One Bed) - PediatricFalse