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This website is devoted to Ambulatory
Payment Classifications (APCs), Ambulatory Patient Groups (APGs) and Related
Hospital Outpatient Payment Topics.
This website was last updated on: March 28, 2009.
Looking For Information on the
Provider-Based Rule?
Click Here To Visit Our Provider-Based Information Toolkit
CY2008 - APC Update - Information
and Analysis
- CMS Makes A Significant Philosophical Change for APCs Starting In CY2008
CMS has decided to significantly increase the packaging in APCs. Table 10, see link below, lists the set of codes that will be packaged starting in CY2008. Note the use of the relatively new Status Indicator “Q” for conditional packaging. This change is only the tip of the iceberg. Clearly, CMS is moving more toward APGs (Ambulatory Patient Groups) in which there is significantly more bundling. In APGs, E/M levels are bundled and there is also Significant Procedure Consolidation in which related surgeries are bundled.
- Table10 – This is the rather lengthy table of procedures that are to be packaged either absolutely (Status Indicator “N”) or conditionally (Status Indicator “Q”). Be certain to run sample cases through the 2008 APC grouper to understand just how this packaging is taking place.
- CY2007 To CY2008 APC Payments - This is a spreadsheet comparing CY2007 payments and CY2008 payments.
- November 27, 2007 APC Federal Register – In case you need a copy of the full Federal Register entry as a PDF. Note that the Examination Copy is also available in MS Word format. The word processing format can be easier to manipulate. Here is a link, November 1, 2007 Examination Copy.
- Ambulatory Surgical Centers (ASCs) Move To APCs (Well, Sort Of!)
ASCs have moved to APCs starting January 1, 2008. This movement to APCs is only a part of the new ASC payment system as developed by CMS. Note the following:
ü The ASC payment for a given surgical procedure is the lesser of:
o 65% of the APC payment OR
o The Non-Facility Practice Expense (PE) RVU (Relative Value Unit) from the Medicare Physician Fee Schedule (MPFS), that is, RBRVS (Resource Based Relative Value System)
ü Office-based procedures have now been added to the official ASC surgery list. ASCs will receive payment for surgical procedures that are often performed in the physician’s office.
ü Physician payment for services provided in an ASC will be based on RBRVS with the Site-of-Service (SOS) differential in place just as the physician payment is reduced in hospital provider-based situations.
ü Thus ASC and/or hospital personnel will need to know and understand both APCs and RBRVS in order to understand how ASC payments are being calculated and made.
While these points are only a summarization, clearly the ASC payment system has become significantly more complicated. Also, there are questions about how all the features of APCs are to translate over to ASCs. Note that ASCs will generally be included in the APC update process from CMS.
CY2007 - APC Update - Information
and Analysis
- November 24, 2006, APC Federal Register - This is the total Federal Register in a single file.
CY2006 - APC Update - Information
and Analysis
- November 10, 2005, APC Federal Register - This is the total Federal Register in a single file. (Note: This is a very large file; more than 50 MB.)
CY2005 - APC Update - Information
and Analysis
- Total November 15, 2004, APC Federal Register This is the total Federal Register entry in one file. A single file is much easier to perform keyword searches in Adobe Acrobat. Enjoy!
- Table 19 This is the listing of the correlation of C-Codes to associated procedure codes.
- Table 20 This is the listing of the C-Codes that must be on the claim forms.
- CY2005 vs. CY2004 vs. CY2003 vs. 2002 APC Payments Analysis With all of the changes in the APC categories this type of analysis is difficult, but it still gives you some idea as to how the APCs are changing.
- Simplified ED APC Impact Analysis for CY2005
CY2004 - APC Update - Information
and Analysis
- Total November 7, 2003, APC Federal Register This is the total Federal Register entry in one file. A single file is much easier to perform keyword searches in Adobe Acrobat. Enjoy!
- CY2004 vs. CY2003 vs. 2002 APC Payments Analysis With all of the changes in the APC categories this type of analysis is difficult, but it still gives you some idea as to how the APCs are changing.
- Simplified ED APC Impact Analysis for CY2004
CY2003 - APC Update - Information
and Analysis
- Total November 1, 2002, APC Federal Register This is the total Federal Register entry in one file. A single file is much easier to perform keyword searches in Adobe Acrobat. Enjoy! Note that this is a large file - a slow connection is not recommended!
- CMS CY2003 - CMS APC Update CY2003 Files - These are MS Word and MS Excel Files. If you are doing any analysis, these files are very useful. Also, there are additional data files provided.
- CY2003 vs. CY2002 APC Payments Analysis With all of the changes in the APC categories this type of analysis is difficult, but it still gives you some idea as to how the APCs are changing.
- Status N CPT/HCPCS Codes For CY2003 - Billable/Codeable
- Status E CPT/HCPCS Codes For CY2003 - Noncovered Items
- Simplified ED APC Impact Analysis for CY2003
- New Codes As Reported for the CY2003 APC Update
- Deleted Codes, Status="DG" or "DNG" for CY2003
August, 2002, Update For Provider
Based Status
- Dr.
Abbeys Comments For The August 9, 2002, Federal Register - Dr. Abbey's
Comments For The
August, 2002, Update For Provider
Based Status
- August
1, 2002 Update For Provider-Based Status (PBS) Rules - This PDF file
contains the pages from the
CY2002 - APC Update - Information
and Analysis
- HCFA
FY2002 - CMS
- CY2002 vs. CY2001 APC Payments Analysis
- Status N CPT/HCPCS Codes - Billable/Codeable
- Status E CPT/HCPCS Codes - Noncovered Items
- March 1, 2002, APC Update Federal Register
Download the EMTALA and Provider-Based
Status [proposed] rules from the Federal Register updates (
The APC Final Interim Rules were
released in Federal Register Form on
Search with the keyword of ‘Medicare’
and put in the April 7th date. Note there are 8 separate sections. Be certain
to download each of them! AACI has put the entire FR entry into a single PDF file. This file is
approximately 2.2 MB. Having the complete file will allow you to search it by
keyword using the Adobe Acrobat reader. Download here!
Complete
Go to the Corporate Web Site of Abbey
& Abbey, Consultants, Inc., at:
If you are looking for the comments made by Dr. Abbey and the consultants at
AACI for the
August 24, 2001, Federal
Register Comments This is an MS Word file - 31 Kb.
August 24, 2001, Federal
Register Comments This is in PDF - 15 Kb.
Technical Component E/M Comments
This is an MS Word document - 65 Kb.
Technical Component E/M Comments
This is in PDF - 44Kb.
Bookmark this site and then come back after HCFA
© Copyright 2001-2008 Abbey & Abbey, Consultants, Inc.- All rights reserved. Site published by AACI. Site design by JDA.