Health Information Management

Tip: Determine the impact of comprehensive APCs on your facility

APCs Insider, March 13, 2015

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

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.

Want to receive articles like this one in your inbox? Subscribe to APCs Insider!

    Briefings on APCs
  • Briefings on APCs

    Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...

  • HIM Briefings

    Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...

  • Briefings on Coding Compliance Strategies

    Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...

  • Briefings on HIPAA

    How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...

  • APCs Insider

    This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...

Most Popular