How the New APCs Will Affect Reimbursement
Published on Sat Jul 01, 2000
The 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 to Aug. 1.
These new codes 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 neurosurgeons and other Part B providers code and bill for services for Medicare patients. This is true even if the hospital is doing the neurosurgeons billing. There are ways, however in which the neurosurgeon 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, they no longer may make them available and that will affect the neurosurgeons 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 doesnt get paid, theyre going to suffer, and ultimately, that affects where we are going to perform our procedures and what procedures we may 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 neurological practices, reports that neurosurgeons writing chart documentation for outpatient procedures such as electromyograms (EMGs, 95860-95872), nerve conduction studies (95900-95904), epidural blocks (62310-62319, 64479-64484), and any other procedures performed on Medicare patients at hospitals or outpatient facilities will have to be extremely accurate and extensive for hospital and outpatient facility coders to bill properly.
For example, a common neurosurgical outpatient procedure is carpal tunnel release (29848). If the neurosurgeon simply indicates carpal tunnel release on his or her chart notes, the hospital coder may erroneously bill this as 64721 (neuroplasty and/or transposition; [...]
