Health Information Management

Pay-per-view: History shows importance of proper cost reporting

APCs Insider, August 9, 2013

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Providers setting charges based on an understanding of their costs is not a new concept, says Jugna Shah, MPH, president and founder of Nimitt Consulting. However, providers struggle with this or fail to do it correctly, and then stand to deteriorate their future payment rates since CMS relies on provider data to set payment rates not only for inpatient and outpatient services, but also for laboratory services.

Commenting to CMS about payment rates can and has benefited providers over the years. For example, in 2011 the AMA released combination CPT® codes for CT of the pelvis and abdomen and since CMS felt it had no historical data upon which to base payments for what it considered “new services” since there were new codes, it simply assigned them to the existing APCs with payment rates that only reflected the single CT and not the combined resulting in payment rates far too low to cover the costs of providing two services.

Continue reading History shows importance of proper cost reporting on HCPro’s website. Subscribers to Briefings on APCs have free access to this article in the August issue.

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