HOPPS stands for which payment system?

• A. Hospital Outpatient Prospective Payment System
• B. Hospital Operating Payment Schedule
• C. Hospital Outpatient Pricing System
• D. Health Organization Payment Standards

Answer: (A)

HOPPS is the Hospital Outpatient Prospective Payment System used by Medicare to reimburse hospital outpatient services. It’s a prospective system, meaning payment rates are set in advance based on ambulatory payment classifications (APCs) that group similar outpatient services and procedures. Each outpatient service or procedure is assigned to an APC and paid a fixed rate, with adjustments for factors like facility vs nonfacility billing and occasional outlier or pass-through payments for new technologies. This system specifically covers outpatient care in hospital settings, and is distinct from inpatient payments (IPPS) and from professional fee schedules. The other options don’t reflect Medicare terminology for this outpatient reimbursement framework.