Health Information Management

Q&A: Why are we not getting paid for observation APCs?

APCs Insider, March 21, 2014

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Q: Our reimbursement department says that we are no longer being paid for APCs 8002 and 8003 for the observation composite services. Did CMS stop reimbursing for observation services?

A: For 2014, Level I and II Extended Assessment and Management Composite APCs were combined into one APC. CMS created new the APC 8009, Extended Assessment and Management (EAM) Composite, to provide payment for all qualifying encounters rather than recognizing two levels of EAM composite APCs. The same parameters apply for triggering the composite APC, but only one level of payment will be made.

Editor’s note: Denise Williams, RN, CPC-H, vice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Fla., answered this question.

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