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APC Changes  
brianhiestand
Posted: Thursday, July 23, 2015
Joined: 4/19/2011
Posts: 6


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.

 

RJW

 

Robert Wagner, MD, FACEP
Partner

Subsidium Healthcare

robert_wagner@schumachergroup.com
C 912.531.2194

O 337.354.1395

F  337.262.9719


Brian Hiestand MD, MPH, FACEP
Associate Professor of Emergency Medicine
Wake Forest School of Medicine
bhiestan@wakehealth.edu
   
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