Question

Ambulatory Patient Classification (APC) is a system for reimbursing acute care facilities for outpatient services, which was developed because of success of DRGs.

Provide a response to the following:

1. As it relates to APC's, define the term packaging.

2. As it relates to APC's, define the term discounting.

3. Define the following APC status indicators: A, C, G, H, and T.

4. As it relates to APC's, define the term pass-through items.

5. Explain the Medicare payment determination process for APC payments.

Answer 1

Introduction

Ambulatory Patient Classification (APC) is a system for reimbursing acute care facilities for outpatient services, which was developed because of success of DRGs.

Provide a response to the following:

1. As it relates to APC's, define the term packaging.

As it relates to APCs packaging is when reimbursement for minor ancillary services associated with a significant procedure has been combined into a single payment for a procedure.

2.As it relates to APCs, discounting is when multiple surgical procedures with payment status indicator T performed during the same operation season.