Reader Question: APCs and Clinics

Question: How will clinic visits (clinics associated with hospital visits), and outpatient clinics be affected by APCs? Are the APCs going to be assigned to those as well?

Barbara Gedwill
Mequon, Wisc.

Answer: Medicares outpatient prospective payment system (OPPS) applies only to outpatient hospital services.
Physician offices that are attached to, or associated with, hospitals are affected only if they are considered to be part of a provider-based clinic. If a physician simply rents office space in a hospital-owned building, the office is not considered to be provider-based and thus would not be affected by the OPPS.

Outpatient services performed in hospital-owned, provider-based clinics are included in the OPPS and would be reimbursed by APCs.

- Published on 2000-10-01