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APC Changes  
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.




Robert Wagner, MD, FACEP

Subsidium Healthcare

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
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