Health Information Management

News: Outpatient payments move toward DRG-type model

CDI Strategies, November 20, 2014

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CMS’ finalization of its comprehensive APC (C-APC) policy represents the most radical change finalized in the 2015 OPPS final rule. C-APCS introduce an inpatient-like complexity adjustment for outpatient hospital services. The policy will be implemented January 1, 2015, with 25 C-APCs with expansion of the system in subsequent years.

CMS finalized a policy to recognize more complex cases and to pay for them accordingly using a complexity adjustment. When the facility reports one of these combinations, CMS will increase the payable APC to the next higher APC in the clinical group, similar to DRGs on the inpatient side.

Editor’s Note: This article is adapted from

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