Certified Coding Associate (CCA) Practice Exam

The correct answer is OPPS, which stands for the Outpatient Prospective Payment System. This system is specifically designed for billing outpatient services provided to Medicare beneficiaries, including radiology examinations. Under OPPS, facilities are reimbursed based on a predetermined rate for each service, which is derived from the APC (Ambulatory Payment Classification) system.

The OPPS is significant because it enables more predictable costs for outpatient care, and it incentivizes efficiency in providing services. Each outpatient service, such as radiological examinations, is categorized, and a specific payment is assigned based on these categories. This helps healthcare providers manage costs better while ensuring they receive adequate compensation for services rendered.

In contrast, other options like RBRVS (Resource-Based Relative Value Scale) primarily apply to physician services, DRG (Diagnosis-Related Group) pertains to inpatient hospital services, and fee-for-service is a broader payment model where individual services are billed separately rather than being bundled as in OPPS. Therefore, OPPS is uniquely applicable to the outpatient setting regarding Medicare payments for radiology services.