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opps: payment calculator — APC-based reimbursement #265

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opened 2026-03-25 19:54:09 +00:00 by kert · 0 comments
kert commented 2026-03-25 19:54:09 +00:00
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Objective

Calculate OPPS payment rates for a given APC, year, and facility type.

Mirrors pfs.calcs which computes PFS payment from RVU + GPCI + conversion factor.

Tasks

  • src/opps/calcs/ — payment calculation from APC weight × conversion factor
  • Handle: hospital outpatient, ASC, cancer hospital
  • Wage index adjustment by CBSA
  • Pass-through payment calculation for biologicals/devices
  • Skin sub specific: model old (ASP+6%) vs new (flat rate) payment
## Objective Calculate OPPS payment rates for a given APC, year, and facility type. Mirrors `pfs.calcs` which computes PFS payment from RVU + GPCI + conversion factor. ## Tasks - [ ] `src/opps/calcs/` — payment calculation from APC weight × conversion factor - [ ] Handle: hospital outpatient, ASC, cancer hospital - [ ] Wage index adjustment by CBSA - [ ] Pass-through payment calculation for biologicals/devices - [ ] Skin sub specific: model old (ASP+6%) vs new (flat rate) payment
kert added this to the P31: OPPS Module — outpatient payment system parity with PFS milestone 2026-03-25 19:54:09 +00:00
kert closed this issue 2026-03-26 06:14:37 +00:00
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Reference: homelab/stack#265
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