APCs 101

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APCs 101

• Presented by
• Susan Magdall, CPC, CHC
• Nancy Gast, Executive Director
• Institutional Compliance Program

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APCs 101

• History
• APCs
• Reimbursement

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History of APCs
1983 Inpatient DRGs implementation 1988 HCFA
awards 3M grant to develop APGs 1998 Sept. 8,
1998 Federal Register Proposed Rule 2000 April
1, 2000 Outpatient PPS implemented with 451
APCs 2001 Currently 1,628 APCs
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What is an APC??????

• Ambulatory Payment Classification
• CPT codes for
• facility fees (includes overhead,
• nurses salaries, support staff salaries,
• electricity, and water)
• equipment
• supplies

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What is an APC contd.

• CPT codes do not need to group
• CMS groups using grouper
• Can have multiple APC groups per
• claim

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APCs are not .

• Physician/NPP services
• Professional services
• Lab, DME (already on fee schedule)
• Dialysis/ESRD

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Three Parts of a Charge

• Professional
• Technical
• Facility Fee

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Facility Fee
Physician and facility fees for E/M levels do not
have to match Here at UTMB we select a level
equal to or greater based on the resources used
which is measured by nursing time 5 E/M codes
3 levels
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REIMBURSEMENT CHANGES

• Cost Report
• Cost Report - DRGs
• Cost Report - APCs