Corporate Compliance

Can you explain, and also provide examples of, the types of services that contribute to the cost of ED visit level APCs but are not paid separately?

Compliance Monitor, June 1, 2007

Q: Can you explain, and also provide examples of, the types of services that contribute to the cost of ED visit level APCs but are not paid separately?

A: There are several types of costs that contribute to the resources used during an ED visit but are not separately charged to the patient. Consider these costs when you develop prices for ED visit levels and procedures.

Nursing- and ancillary-staff time is probably the largest cost to the hospital. In addition, several other healthcare workers and support staff members may interact or become involved with an ED patient encounter. This includes the registration clerk, ED medical assistants, or technicians who might assist in a patient's care, other ancillary service personnel such as security guards, social workers, discharge planners, dietary technicians, case managers, pastoral care, and even hospital management.

Other costs include use of the ED room, general equipment and supplies that cannot be separately charged, medical record creation, other HIM costs, coding, billing, and a portion of department overhead that might be allocated to each visit for utilities and waste disposal, etc.

Editor's note: This Q&A is adapted from the May 2007 issue of APC Answer Letter.

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