Question

1. What are APC groups? explain in detail

2. How are physician's paid? What are RBRVS? Explain the Physician Fee Schedule look-up tool.

3. List the Functions of the OCE

Answer 1

1. APC ( Ambulatory payment classification) groups:-
-APC is the US government method of paying for facility outpatient services for the Medicare health program.
-It is part of the Federal Balanced Budget Act which create a new Medicare OPPS(Outpatient Prospective payment system).
-APC are made to hospitals when outpatient is discharged or transferred to another hospital.

2. RBRVS (The resource based relative value scale):-
-It is the physician payment system used by the Centers for Medicare & Medicaid Services (CMS) and most other payers.
-It is based on principle that payments for physician services should vary with the resource costs for providing those services and is intended to improve and stabilize the payment system while providing physicians an avenue to continuously improve it.
-In RBRVS payments are determined by the resource costs needed to provide them.

FUNCTION OF OCE (Integrated Outpatient Code):-
-The software performs the following functions when processing a claim:-
-Edits a claim for accuracy of submitted data
-Assigns CMS designated status indicators
-Assigns payment indicators
-Determines a claim disposition based on generated edits.