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Ambulatory Payment Classification (APCs) In-Depth: Understanding Comprehensive APCs

March 5 @ 11:30 am - 1:00 pm MST

$160 – $320

Starting in 2008 CMS started increased bundling for APCs. At first this was simply at the procedure level generally using SI=”N” in order to effect the bundling. Then Composite APCs were developed and the evolution continued on to comprehensive APCs or C-APCs. C-APCs represent significant bundling using the “J1” and “J2” status indicators.

For 2016 and 2017, CMS has moved rapidly to increase the number of C-APCs and this trend is likely to continue. The basic philosophy is that APCs in general represent a prospective payment system in which there should be significant bundling similar to that which is found in DRGs. Historically, the precursor to APCs was APGs (Ambulatory Patient Groups) in which there was significant bundling through significant procedure consolidation. With the rapid deployment of many C-APCs, hospitals have a very difficult time assessing the financial impact that C-APCs engender.

Dr. Abbey will review and clarify the various bundling techniques, discuss status indicators for APC grouping processes, discuss C-APCs and discuss additional steps to mitigate the impact of C-APCs.

At the completion of this program, the participants will be able to:
  • Discuss the historical perspective of Significant Procedure Consolidation found with APCs.
  • Explain the use of status indicators to drive the APC grouping process and thus the adjudication of claims.
  • Identify the types of APC categories that are amenable to C-APCs.
  • Discuss what is bundled or not with C-APCs.
  • Evaluate the potential of statistical variation within the C-APCs.
  • List different scenarious for C-APCs in order to develop cost versus payment estimates for a given hospital.
  • List steps that can be taken to mitigate the impact of C-APCs.

This session is recommended for health care outpatient clinical and departmental staff, physicians, nurses, compliance personnel, billing, coding and claims personnel, cost accounting personnel, cost report personnel, financial analysts and planners, chargemaster coordinators, and others interested in APCs.

Dr. Duane Abbey is a management consultant and president of Abbey & Abbey Consultants. For over 20 years, Dr. Abbey has provided health care consulting services to hospitals, physicians, and medical clinics. The focus of his consulting has been in the areas of compliance, payment and delivery systems. In addition to his consulting, Dr. Abbey is an invited presenter for hospital associations, medical societies and other groups. He has also published articles and books on health care topics. The speaker has no real or perceived conflicts of interest that relate to this presentation.

5:00 p.m. MST; February 26, 2019


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March 5
11:30 am - 1:00 pm (MDT)
$160 – $320
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