HCFA's final rule on APCs is out: ED managers can breathe sighs of relief.
The final rule on ambulatory payment classifications (APCs) for outpatient services from the Health Care Financing Administration (HCFA) was published in the April 7, 2000, Federal Register, with a July 1, 2000, implementation date. EDS might receive increased reimbursement for services under APCs, in sharp contrast to previous predictions of a 15% decrease in reimbursement. Instead of combining CPT and ICD-9-CM coding for clinic and emergency visits APCs, HCFA has assigned three APCs for the emergency department and a fourth APC for critical care. There is no APC for a medical screening exam, which could improve reimbursement. There is no separate APC for observation services, which means no additional payment will be given. You can continue to use your current charge structure and correlate present levels of service with the appropriate CPT visit level. You will have to "unbundle" visit levels to list nursing and physician procedures separately as specific line items.
D000553:Ambulatory Care / Q000145:classification* / Q000191:economics; D014487:Centers for Medicare and Medicaid Services, U.S.; D004636:Emergency Service, Hospital / Q000191:economics*; D011445:Prospective Payment System; D014481:United States