How Several Facilities Use Task Forces to Prepare for APCs

Now that ambulatory payment classification (APC) regulations have been published, the new outpatient prospective payment system is at the top of everyones list. Unfortunately, facilities that have waited until now to gear up for APCs may have some trouble getting ready for the changes, but they can still get there, according to Julie Langdon, RN, director of process improvement at Fort Sanders Sevier Medical Center in Sevierville, Tenn. It will force facilities to take an interdepartmental look at all their processes that relate to documentation of services and charges.

Fort Sanders transformed its existing denials management team into a reimbursement and compliance team early this year. Its job was to prepare the hospital for APCs.

North Bay Healthcare System in Fairfield, Calif., also created its task force early this year, says Christine Sarrico, vice president of finance for the system. The task force is working to improve documentation of services provided. Thats the one area weve recognized that we have to do a better job. Historically, hospitals havent paid the attention that doctors and medical groups have.

Setting Up the Task Force

The first step in the APC preparedness process is setting up the task force. Langdon and Sarricos facilities created large teams, including representatives from the business office, medical records, information systems, finance, and the emergency room physicians group.

Wayne Memorial Hospital in Goldsboro, N.C., took a different tack, according to Carol Fowler, director of health information management. The finance director chose members from medical records, the business office and information systems. Wayne Memorial will call in ancillary departments as needed.

Regardless of the size of the team, it must include people from the departments needed to provide input, Fowler explains, because the changes demanded by APCs will affect many areas of the facility.

Every hospital or outpatient facilitys task force must develop its own APC preparedness plan, and no two will be identical. But the following actions suggested by Sarrico, Langdon, and Fowler are relevant for most facilities:

1. Start looking at the regulations. In printed form, the APC rules comprise more than 1,000 pages. Determining the effect of those regulations will require some effort, but hospitals can contract with consultants or send people to Medicare seminars (visit The Health Care Financing Administrations [HCFA] Web site at http://www.hcfa.gov to learn more about dates and times) if they dont have the staff to do the analysis in-house.

You should start with the rules index, which breaks the regulations down by topic. Begin with the subjects that concern you most and work your way through.

2. Educate facility managers. Administrators are more likely to commit time and resources to dealing with APCs if they understand the breadth of changes they will require. The task force must determine how to [...]

- Published on 2000-06-01