How the New APCs Will Affect Reimbursement
Published on Sat Jul 01, 2000
The new ambulatory payment classification (APC) regulations set forth by the Health care Financing Administration (HCFA) will soon take the thousands of codes that are used for outpatient services and consolidate them into a smaller group of 451 APCs. This new programs effective date has changed from July 1, 2000, to Aug. 1, 2000.
These new payment groups will take into consideration every aspect of outpatient care, including usage of medical supplies, staffing efficiencies, and several other operational costs. Further, coders will be required to use them in outpatient clinics, emergency departments, diagnostic radiology, respiratory therapy, and ambulatory surgery centers. According to HCFA estimates, these codes will result in a potential 4.6 percent average increase in Medicare payments for hospitals and outpatient facilities.
How Reimbursement Is Affected
The APCs will not directly impact the way neurologists and other Part B providers code and bill services for Medicare patients. This is true even if the hospital is doing the neurologists billing. There are ways, however, in which the neurologist may be affected.
Jack Turner, MD, PhD, medical director for documentation, coding and compliance with Team Health, a physician staffing company in Knoxville, Tenn., says that if hospitals and outpatient facilities begin to lose money on certain procedures or services, they may no longer make them available and that will affect the neurologists potential earnings and ability to provide the best possible care to his or her patients.
What we have to recognize is that what we write on a chart, what medications and tests we order, and what procedures we perform will now greatly influence the bottom line of the hospital, Turner says. We have to be concerned about how the hospital will fare with this new system of reimbursement. The physician who is performing outpatient procedures needs to consider the well-being of the hospital as well as the well-being of the patient. If the hospital does not get paid, they are going to suffer, and ultimately, that affects where we are going to perform our procedures and what procedures we perform.
Catherine A. Brink, CMM, CPC, president of Healthcare Resources Management Inc., a practice management and reimbursement consulting firm in Spring Lake, N.J., that consults with several neurology practices, reports that neurologists writing chart documentation for outpatient procedures such as electromyograms (EMG, 95860-95872), nerve conduction studies (95900-95904), epidural blocks (62310-62319, 64479-64484), and any other procedures performed on Medicare patients at a hospital or outpatient facility will have to be extremely accurate and extensive for hospital and outpatient facility coders to bill properly.
For example, a common outpatient procedure performed by neurologists is 95925 (short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the [...]
