Management
Question # 1
10 Different Types of APCs under OPPS
The unit of payment under OPPS in most of the cases is APC. CMS allocates each services of Hospital a common procedure code to APC based on similar clinical feature and cost. The rate of payment and co-payment is calculated for an APC that is applied to each service within in APC. Sometimes newly introduced services are assigned to new technology of APC, which are depend on similarity of resource used, until cost of data are available to permit assignment to APC clinical .
Packaging is the critical feature of Outpatient Prospective Payment System that is a potential of payment system. Within each APC payment for reliant, auxiliary, supportive, and adjunctive points and services is packaged into payment for the primary sovereign service. Payments are not paid separately for packaged services, which are considered a significant part of service paid under the OPPS.
Services which are included within the OPPS system are all outpatient services of hospital that have not been described as packaged services. Amongst the types of services that are classified by CMS into APC groups of payment under Outpatient prospective payment system are given below;
- Supplies/ Equipments
- Drugs, Biological and Pharmaceuticals
- Visits of Emergency Department
- Procedures of Surgery
- Diagnostics tests and other diagnostic services
- Pathological Surgery
- Chemotherapy for Cancer
- Critical Care
- Implantable items
- Observations services etc.
Question # 2
Concept of APC Discounting
The APC system will maintain two types of discounting:
More than one surgical practice executed during the identical operative session. Full payment is made for the procedures with the highest payment rate (or weight), and all other procedures are discounted 50 %. Manifold surgeries supplied through the similar performing period are discounted . The discounting of numerous procedures recognizes the savings that result when more than one practice is executed at the same period, and costs such as patient preparation, performing room use, and recovery room time are shared. Of the 180 significant-practice APCs, 133 are eligible for this type of discounting.
Services or procedures that are terminated when a patient is prepared for surgical procedure, but prior to anesthesia (recognized by practice adapt), will be remunerated at 50 % of the standard imbursement amount. Fifty percent of the full OPPS total is remunerated if a practice for which anesthesia is planned is discontinued after the patient is get ready and taken to the room where the practice is to be executed but before anesthesia is provided .. A procedure that is not continued after it is initiated, such as an incision made, intubation begin, or extent introduced, will receive the full payment amount.
Question # 3
Question # 4
CPT codes APC Status Indicator Relative Weight Payment Rate
Facility’s estimated reimbursement
The reduction in reimbursement resulting from OPPS has been estimated to range from $50 to $105 in this claim.
References
Booyens, S. W. (2008). Introduction to Health Services Management. Perth: Juta and Company Ltd.
Marie Eloïse Muller, M. M. (2012). Health Care Service Management. Miami: Juta and Company Ltd.
Sharon B. Buchbinder, N. H. (2011). Introduction to Health Care Management. New York: Jones & Bartlett Publishers.
