BALANCED BUDGET ACT AND APCs:
How Will They Affect You?

Presented by Todd M. Husty, D.O.

 

INTRODUCTION

With the introduction of Ambulatory Payment Classifications (APC), hospitals will be faced with yet another coding system to master Similar to DRGs, the APC system will change the factors that influence reimbursement for the facility. Physician documentation will drive APC assignment, therefore, physician’s documentation will come under severe scrutiny. The amount of resources a physician utilizes will bear new importance. Physicians as well as facilities need to begin now to master this coding process so that by implementation (tentatively July. 2000) guidelines will be in place as well as needed improvements in areas such as documentation and utilization.

 

LEARNING OBJECTIVES

The attendee will learn the following:

• Definition of APCs

• Significance of APCs on reimbursement

• Impact on Hospital Function and Utilization

• How to Prepare Physicians for APCs

 

DISCUSSION

• Discussion will focus on the following topics:

• Comparison of APC methodology to DRG system

• How the physician may begin preparation of APCs

• How the facility/physician can work together on implementation within the scope of

• Auditing

• Marketing

• Monitoring

• Training

• What is Known -- and Not Known about the implementation

 

SUMMARY

Documentation will drive the APC system -- both for the physician and hospital

Training and implementation strategies should begin now

Physicians hold the keys for success or failure.

 

REFERENCES

"Medicare Program; Prospective Payment System for Hospital Outpatient Services; Proposed Rules," Federal Register Department of Health and Human Resources, Health Care Financing Administration, Office of Inspector General September 8, 1998, pp. 47552-48036.

"Medicare Program; Prospective Payment System for Hospital Outpatient Services; Proposed Rules," Federal Register, Department of Health and Human Resources, Health Care Financial Administration, Office of Inspector General, June 30, 1999, pp. 35258-35513.

St. Anthony's Guide to APC and ASC Groups, St. Anthony’s Publishing Company, November 1999 pp. APC1 -APC3O.

APC Reference Manual, St. Anthony’s Publishing Company. October, 1999, pp. I-I through 1-26, Appendix A-I through A10.

 

CONTACT INFORMATION

 

Medical Audit Resource Services, Inc.

One Purlieu Place Suite 160

Winter Park, FL 32792

1-877-771-7373

(407) 657-5020

E-mail address: marsiout@iag.net

For additional information regarding the implementation of APCs addressed in this presentation or for information regarding coding evaluation and review programs on the outpatient/inpatient facility and physician practice.

Medical Audit Resource Services Inc. offers compliance review programs tailored to the needs of each individual facility or practice focusing on reviewing, education and support.