How Will Shift to APCs Affect ED Professional Coding and Reimbursement?
Published on Sat May 01, 1999
In the last issue of ED Coding Alert we covered the initial preparations hospital information personnel should take to prepare for the shift to Medicares prospective payment system for outpatient services, which will take effect next year. We have also received several inquiries about the potential impact the new ambulatory payment classifications (APCs) will have on reporting ED professional services.
The good news for emergency group professional coders is that APCs will not affect their ED coding. They may, however, have a significant financial impact on the emergency medicine group, influencing how the group documents and reports its services, says Jeffrey Bettinger, MD, FACEP, chair of the American College of Emergency Physicians (ACEP) subcommittee on hospital prospective payment systems.
It is important to tell your readers that physician payments are not included in the APCs, he emphasizes.
However, he adds, ACEP is following the development of the APC system for several reasons. First, is the potential negative financial impact on the hospital, which could in turn affect the emergency groups contracts. Second, there will be increased scrutiny of the drugs and supplies ordered by the emergency physician because this also will affect the hospitals reimbursement. Third, there is a possibility that, in the future, Medicare may decide to pull physicians payments into this as well, says Bettinger.
Emergency physician groups need to be aware of the issues that may affect them. Here are some things to begin considering.
How are Components Bundled into
the APCs?
Impressively, there are almost 60 different APCs that cover ED visits and services, says Bettinger. They include for the hospital all of the nursing time, and they also include supplies that will be used. They do not include fees for diagnostic and lab studies which are covered under a separate fee schedule, and x-rays, which have their own APCs.
Basically, he contends, physicians will come under scrutiny if they prescribe expensive medications or supplies, where less expensive ones could possibly be substituted.
The hospital administrator is going to say, I am only getting x amount of dollars for this service. If you use the most expensive medicines or supplies, I am not getting anything for it.
Currently, all hospital charging is cost basedthe more expensive the medicine or supply the higher the hospital charge. All of that is changing.
It will be sort of like forcing HMO constraints on ED physicians in a respect, Bettinger notes. They are going to have the hospital looking over their shoulders more and more.
Increased Emphasis on Documentation
Because the level of E/M service delivered in the ED will largely determine the APC that is allocated for each visit, the hospital will begin depending more on physician documentation, predicts Bettinger.
Documentation will no longer just be important for the physicians bill; [...]
