OverviewofAmbulatoryPaymentClassifications.pptVIP

Ambulatory Payment ClassificationsAPCs Definition APC stands for Ambulatory Payment Classifications System for reimbursing acute care facilities for outpatient services e.g., Outpatient Prospective Payment System or OPPS Developed because of success of DRGs History of APCs OBRA – 1986 CMS directed to develop OPPS 3M won bid 1988 APGs developed by 1990 but not implemented BBA – 1997 CMS to implement PPS by 1999 BBRA - 1999 APCs implemented 2000 What are APCs?? Outpatient Payment Groups Groups of codes with a fixed payment amount Based on HCPCS codes Both Level 1 and Level 2 used Codes in the same APC must have Comparable clinical aspects Comparable resource consumption Why Another Payment System? There was a rapid growth in outpatient services and ambulatory care expenditures and payments. Some of the reasons were: Cost efficiency incentives in the inpatient PPS DRGs Medicare’s 1982 decision to qualify and recognize facility payment of ASCs Ambulatory Surgical Centers Some private insurer incentives to hospitals to treat their beneficiaries in the outpatient setting The decline in inpatient revenue due to DRGs Advancements in medical technology i.e. anesthetics and laparoscopes Purpose of APCs Cost control Efficiency Facilitate payment Address beneficiary coinsurance issues Key Aspects of APCs Packaging Services like laboratory still paid on a fee schedule basis , most supplies, anesthesia, intraocular lenses, and observation care are included in the APC payment Drugs, pharmaceuticals, and biologicals usually not bundled Discounting Multiple procedures provided during the same patient encounter are provided at lower cost than they would be if provided at separate encounters Applies to services with status indicator T Key Aspects of APCs Fixed payment rate Hospitals and payers know in advance how much they will be paid for certain services Three Year Transition Period Transitional corridors allowed for a three-year period that limited the payment reducti