I have never dealt with APCs in my office but am trying to match up some EOBs with statements from a psychiatric treatment facility, and it isn't working, so need some help. My understanding of APCs is that a hospital will profit if the payment rate is higher than the cost of care provided, or lose money if the payment rate is lower. Here's the scenario:
Facility is outpatient facility of a hospital, so 2 Medicare checks are received.
Med check fee $ 90
Medicare reimburses based on fee of $108
Medicare A pmt $ 14.98
Medicare B pmt $ 63.10
Statements show an "APC adjustment discount" of $18.84, which they tell me they have to reimburse to Medicare, so it is added back on to patient's statement. Does this make sense to anyone? Can you explain it to me? My thought is that this is hogwash and the facility is stealing from patient, but I'm sure one of you can make it make sense for me. Thanks.
Facility is outpatient facility of a hospital, so 2 Medicare checks are received.
Med check fee $ 90
Medicare reimburses based on fee of $108
Medicare A pmt $ 14.98
Medicare B pmt $ 63.10
Statements show an "APC adjustment discount" of $18.84, which they tell me they have to reimburse to Medicare, so it is added back on to patient's statement. Does this make sense to anyone? Can you explain it to me? My thought is that this is hogwash and the facility is stealing from patient, but I'm sure one of you can make it make sense for me. Thanks.