Dear Subscriber

Dear Subscriber:

As we get closer to the ambulatory payment classification (APC) implementation date and more information becomes available, our initial panic seems to be subsiding and is being replaced by excellent information from many sources.

Many hospitals have completed much of their implementation plan and have systems in place to identify the dramatic differences that the APC system will bring about. Much work still needs to be done, however, to ensure that each department affected by APCs is on board with the system changes.

One group that seems to have been omitted from many in-service programs is the medical staff. Those who erroneously believe that the medical staff have little or no impact on the APC program will need to take a closer look at the coding requirements in the outpatient areas, most specifically, the emergency department.

If the medical staff do not document their services well, the hospital will be prevented from assigning the correct HCPCS procedure code for the service. This could result in delays for billing or lost revenue through coding of a lesser service. Hospitals should begin now to train their medical staffs for their role in the APC process and ensure their cooperation with documentation policies necessary to provide top-quality coding services. In addition, some consideration should be given to the development of a specialized auditing program to provide feedback to those medical staff physicians whose documentation needs fine-tuning.

Perhaps now would be an excellent time to test the system by more closely reviewing emergency department records with documented medical staff procedures to start the process before we go live on Aug. 1. Just another step in the right direction.

Caral L. Edelberg, CPC, CCS-P
President, Medical Management Resources Inc.
Consulting Editor

- Published on 2000-07-01