Evaluating the organizational effectiveness of APC implementation efforts.
To optimize revenue under the Medicare outpatient prospective payment system's new coding-based ambulatory payment classifications (APCs), healthcare providers need to ensure several key steps are taken at the organizational level. Individuals who manage coding need to identify areas of overlap and adjust billing systems to reflect changes under the system. Billing managers should develop practices and protocols that provide detailed reviews of claims, implement a formal denial management program, track reasons for denials, and communicate denial information with their staffs. Proper evaluation of financial practices also is important. Financial managers need to develop formal ways to monitor financial performance consistently and on an ongoing basis and ensure the hospital is generating sufficient volume and keeping service costs in line with payments.
Patel
Rajan
R
Ernst & Young, LLP, Boston, Massachusetts, USA. rajan.patel@ey.com
D000043:Abstracting and Indexing / Q000592:standards; D000553:Ambulatory Care / Q000145:classification* / Q000191:economics; D003953:Diagnosis-Related Groups / Q000145:classification; D017598:Efficiency, Organizational; D006801:Humans; D007344:Insurance Claim Reporting / Q000145:classification*; D006278:Medicare; D015397:Program Evaluation; D011445:Prospective Payment System; D014481:United States