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Course Description

OPPS, in the form of APCs, is now being significantly changed.  The final changes for 2018 continue to involve significantly increased packaging in several forms.  Further changes for device dependent APCs along with changes generated to by cost reporting changes.  Besides composite APCs, we now have comprehensive APCs.  These changes started in 2008 and continue to accelerate with particular attention relative to observation services.  Given additional changes for CPT and HCPCS, the impacts of changes for APCs are revolutional as opposed to evolutional.  Consideration must also be given to how provider-based clinics are being impacted with the implementation of Section 603 of BiBA 2015.

  • Why haven’t APCs stabilized so that the year changes are minimal?
  • What does the increased bundling under APCs mean for our hospital?
  • What is happening with observation services?
  • Are there new special compliance concerns?
  • What are the general trends for the evolution of APCs?
  • How are changes in the cost reporting process affecting APCs?
  • What is the difference between composite versus comprehensive APCs?
  • How is CMS viewing add-on codes for payment purposes?
  • What is all the fuss about status indicators?
  • Are rural SCHs and EACHs affected by the proposed changes?
  • What about all of the other payment mechanisms such as cost outliers and copayment amounts?
  • How are provider-based clinics impacted by implementation of Section 603 of BiBA 2015?

Learning Objectives:

  • To review the many proposed and finalized changes to APCs for 2018.
  • To recognize the general trends for APCs with particular attention to increased bundling.
  • To appreciate changes made relative to observation services, associated packaging and the need for special billing for packaged items that are not normally paid through APCs.
  • To understand how recent changes in the cost reporting process affect APCs payments.
  • To understand the complex nature of APCs and associated compliance issues including RAC concerns.
  • To review changes in grouping with particular attention to new CPT and HCPCS codes.
  • To appreciate the potential financial and operational impact of the proposed changes.
  • To understand how important it is for hospitals to comment to the proposed changes.
  • To understand the difference between composite and comprehensive APCs.
  • To review the possible impact of the proposed change on high impact areas such as observation, the Emergency Department, interventional radiology and associated areas.
  • To review changes to and trends for the Provider-Based Rule (PBR) and the implementation of Section 603 of BiBA 2015.
  • To discuss anticipated future changes and directions for APCs.

Session Agenda:

  1. Review of APC Final Changes for CY2018
    1. Coding/Grouping Changes
    2. E/M Coding
    3. Recalibration of APC Weights
    4. On-Going Problem Areas
    5. Cost Report Changes – Charge Compression
    6. Drugs and Biologics
    7. Cost Outliers
    8. Interventional Radiology
    9. Additional Comprehensive APCs
    10. Inpatient-Only Procedures
  2. APC Trends
    1. Increased Bundling and Packaging
    2. Comprehensive APCs
    3. Shifts In Realigning Payments
    4. Development of Comprehensive APCs
    5. Policy and Interpretive Changes
    6. Impacts of CPT/HCPCS Changes
  • Provider-Based Clinic Changes
    1. CMS Information Collection
    2. BiBA 2015 – Section 603 Implementation
    3. Projecting the Future for Provider-Based Clinics
  1. Associated Proposed APC Changes
    1. Ambulatory Surgery Centers
    2. Related Physician Changes
    3. Clinical Service Area Considerations
    4. RAC Audit Concerns
    5. MedPAC Reports
    6. Associated MPFS/RBRVS Changes
  2. Assessing the Impact of Proposed Changes
    1. Financial Impacts
    2. Coding and Billing Impacts
    3. Other Operational Impacts
    4. APC Compliance Issues
  3. The Future for APCs

Suggested Attendees:

  • Outpatient Clinical Staff
  • Nursing Staff
  • Physicians
  • Outpatient Departmental Managers
  • Nurse Auditors
  • ED Nursing Staff
  • Provider-Based Clinic Nursing Staff
  • Coding Personnel
  • Coding, Billing and Claims Transaction Personnel
  • Internal Auditing Personnel
  • Financial Analysts
  • Revenue Cycle Specialists
  • Compliance Personnel
  • Cost Accounting Personnel
  • Chargemaster Coordinators
  • Cost Reporting Personnel
  • Other Interested Personnel

About The Speaker:

Duane C. Abbey, PhD, CFP, is a management consultant and president of Abbey & Abbey Consultants, Inc., a consulting firm specializing in health care and related areas. Duane earned his graduate degrees at the University of Notre Dame and Iowa State University and has more than 20 years of experience as a consultant. Dr. Abbey works extensively in all areas relating to compliance reviews,coding, billing and reimbursement with particular emphasis on the chargemaster and outpatient payment. His consulting activities include hospitals and physicians based clinics.

In addition to his consulting practice, Dr. Abbey also teaches workshops and makes presentations on a regular basis. He has taught at the University level and speaks nationally. He is a regular presenter for hospital associations, medical societies, Boards of Trustees and various other organizations and groups. In addition, professional societies such as HFMA use Dr. Abbey’s services to present seminars and workshops.

Dr. Abbey is a nationally recognized expert in payment systems. A special area of expertise includes APGs/APCs. He is recognized as the leading expert in the nation in APGs/APCs by the thousands who have attended his seminars, read his publications and/or contracted for his services. Attendees at these seminars over the years have included personnel from hospitals, clinics, integrated delivery systems and multiple consulting firms.

Dr. Abbey is also the author of numerous articles and books including: Compliance for Coding, Billing & Reimbursement, Outpatient Services: Designing, Organizing & Managing Outpatient Resources, ChargeMaster: Review Strategies for Improved Billing and Reimbursement, Ambulatory Patient Group Operations Manual, published by McGraw-Hill and Non-Physician Providers: Guide to Coding, Billing & Reimbursement, Chargemasters: Strategies to Ensure Accurate Reimbursement and Compliance, and Emergency Department Coding &Billing: A Guide to Reimbursement & Compliance published.



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