Health Information Management

Tip: Determine the impact of comprehensive APCs on your facility

APCs Insider, March 13, 2015

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Addendum J of the 2015 OPPS final rule is a spreadsheet that includes several tabs providers can use to find most of the detail they’ll need regarding the financial implications of comprehensive APCs (C-APCs).
 
The first tab lists all the HCPCS codes assigned to C-APCs, as well as each code's APC assignment and payment information. The third tab may be the most important for determining the impact C-APCs will have on your organization. It includes all of the code pairs that will lead to complexity adjustment, as well as which higher-level APC the combinations will lead to.
 
Providers can examine the financial impact of C-APC payment logic by comparing what they get paid for those services today under the 2015 rules and payment rates to what they were paid in 2014.
 
Providers can do this by pulling five claims assigned a C-APC in 2015. Determine which items and services were paid for separately by CMS, then compute what the payments would have been in 2014 when most of the services would have been paid separately.
 
This tip is adapted from “Analyze the impact of comprehensive APCs" in the March issue of Briefings on APCs.



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