Temporary Transitional Payment Adjustments Update

(This information came from TRICARE Reimbursement Manual, Chapter 13, Section 3.) 

When TRICARE® Management Activity (TMA) implemented the Outpatient Prospective Payment System (OPPS) on May 1, 2009, it included the Temporary Transitional Payment Adjustments (TTPA) process for all network and non-network hospitals.

For network hospitals, the five-year transition set higher payment percentages for 10 ambulatory payment classification (APC) codes 604-609 and 613-616 during the first year, with reductions in each of the transition years.

For non-network hospitals, the adjustment covers a three-year period with reductions in each of the transition years for the same APC codes.

As a result, there will be adjustments to emergency room and hospital clinics payments effective May 1, 2012.

Here is a chart that details the TTPA adjustment percentages for the 10 APC codes.

For more information, please refer to the TRICARE Reimbursement Manual, Chapter 13, Section 3. It can be found at TRICARE.mil.

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