The OPPS rule requires hospitals to include all OPPS services on the same claim for what reason?

The requirement for hospitals to include all Outpatient Prospective Payment System (OPPS) services on the same claim is rooted in adherence to the same-day rule. This rule mandates that all outpatient services provided to a patient on the same day must be reported together on a single claim.

This approach enables Medicare and other payers to have a complete view of the services rendered, which streamlines the billing process and helps ensure that all related services are properly linked and accounted for in a comprehensive manner. By following the same-day rule, hospitals can avoid complications that arise from fragmented billing, such as duplication of claims or misalignment between services, leading to a more efficient reimbursement process while minimizing compliance risks.

The underlying principle is to maintain clarity and accuracy in billing, enhancing the integrity of the claims process and ultimately facilitating timely and appropriate payment for services rendered.