OPPS Information Available on the TRICARE Management Activity (TMA) Web Site
TRICARE Management Activity (TMA) implemented the TRICARE Outpatient Prospective Payment System (OPPS) reimbursement methodology on May 1, 2009. TRICARE OPPS applies to all hospitals participating in the Medicare program and hospital-based partial hospitalization programs subject to TRICARE authorization requirements. TRICARE OPPS also applies to hospitals or distinct parts of hospitals that are excluded from the inpatient Diagnostic Related Group (DRG) Based Payment System, to the extent that the hospital or distinct part furnishes outpatient services. Some organizations, as defined by TRICARE policy, are exempt from OPPS.
There is a wealth of information about OPPS on TMA’s Web site at
www.tricare.mil/OPPS. The following documents can be downloaded:
- Ambulatory Payment Classifications (APCs) with Status Indicators (SIs) and Payment Rates – Quarterly
- Payment Status by HCPCS Code – Quarterly
- Payment Status Indicators – Quarterly
- Statewide Cost to Charge Ratios
- OPPS Provider File – Quarterly
- OPPS Pricing Elements
- Zip to Wage Index Crosswalk
Here are some other helpful links on TMA’s Web site:
For more information on OPPS, view the
OPPS Fact Sheet and
OPPS frequently asked questions in the Claims and Reimbursement section of
www.triwest.com/provider as well as in Chapter 13 of the TRICARE Reimbursement Manual at
http://manuals.tricare.osd.mil/.
Published Date:
06/01/2009
