Departments Must Work Together To Ensure Proper Reimbursement

The introduction of ambulatory payment classifications (APC) will force hospitals to do more than just hire a few more coders and buy some new computer software, according to Roger Sipe, director of patient financial services for Newberry County Memorial Hospital in South Carolina. The new system also will cause a shift in the way numerous hospital departments interact, he says.

Sipe is not the only one bracing for monumental changes. Robert Kottman, MD, FACEP, president of Alamo Physician Services Inc., an emergency physician billing service in San Antonio, believes financial risk will shift from Medicare to the hospitals, as it did when inpatient diagnosis-related groups (DRGs) were implemented several years ago.

APCs are designed to create some uniformity in hospital charge submission, Kottman says. This way, there will be a standardized system that everyone will understand and it will create a level playing field for outpatient charges.

Beginning to Prepare

As a result, the Health Care Financing Administrations (HCFA) new codes will cause a lot of shuffling of personnel in various healthcare fields. To prepare for the new scenario, Sipe and his APC team have met with several groups at the hospital to discuss changes in facility procedures in the following areas:

Billing Department. Sipe has had several meetings with billing department managers to educate them about APCs. You dont want to get too detailed, but you want to show them what the financial effect will be. When youre looking at a 13.9 percent revenue loss according to the American Hospital Association, they pay attention.

Coders. Sipe also is introducing coders to the new way of doing things. Were starting to have workshops for the medical coding staff to educate them. Coders are going to be in demand, just as the RN market is. Sipe expects to see coders offered signing bonuses, incentives based on number of claims coded, and other indications which crop up in a tight job market. Theyre going to be the driving force behind this new billing method. If they miss an APC, you dont get compensated. Also, compliance is very important, and you dont want to overcode or undercode.

Physicians. Sipe has been careful to include doctors in the conversations as well. Although APCs wont affect physicians billing directly, every hospital will end up working more closely with its doctors, particularly surgical and emergency room specialists, on the financial side of the business, Sipe says.

Physician Recordkeeping Key

Although nothing in the proposed APC regulations requires facilities to wait for the physicians bill before creating their own, any that dont will be taking a serious risk, Kottman cautions. If the hospital doesnt coordinate its APC Medicare billing with the appropriate procedure code being charged by the physician for his services, theres [...]

- Published on 2000-04-01