Observation Medicine Section Forum
Billing and Finance Discussions
From the email list-serv, courtesy of Dr. Wears
I want to make sure you are aware on the new billing APC and rates for hospitals as proposed in OPPS 2016
The payment for observation goes from $1,234 to $2,111 and the APC goes from APC 8009 to C-APC 8011. The C designates it is a comprehensive APC so the payment covers the ED visit, the Observation hours and all billable services. That benefits patients since their 20% copayment is limited to that one change. They will still be responsible for self-administers medications. This is an increase for hospitals but still probably does not cover the cost of care; it does make it more important that patients "in observation” are handled efficiently with only needed testing.
The comprehensive APC is actually a bundled payment. The result is that hospitals will look to increase efficiencies by decreasing resource utilization including nursing, radiology, lab, length of stay etc.
Robert Wagner, MD, FACEPPartner