If the patient is admitted from a hospital clinic or ED, then there is no APC payment, and Medicare will pay the hospital under the inpatient DRG methodology.Įach APC comprises services similar in clinical intensity, resource utilization and cost. APC payments are made only to hospitals when the Medicare outpatient is discharged from the ED or clinic or transferred to another hospital (or other facility) not affiliated with the initial hospital where the patient received outpatient services. APCs are an outpatient prospective payment system applicable only to hospitals and have no impact on physician payments under the Medicare Physician Fee Schedule. This OPPS was implemented on August 1, 2000. A part of the Federal Balanced Budget Act of 1997 required HCFA (now CMS) to create a new Medicare "Outpatient Prospective Payment System" (OPPS) for hospital outpatient services -analogous to the Medicare prospective payment system for hospital inpatients known as "Diagnosis Related Groups" or DRGs. In addition, this file contains an urban, rural or a low density (qualified) area Zip Code indicator.įor a one-stop resource web page focused on the informational needs and interests of Medicare Fee-for-Service (FFS) providers, including physicians, other practitioners and suppliers, go to the Provider Center (see under "Related Links" below).APCs, or "Ambulatory Payment Classifications," are the government's method of paying facilities for outpatient services for the Medicare program. This file will also map Zip Codes to their State. This file is primarily intended to map Zip Codes to CMS carriers/Medicare Administrative Contractors and localities. ZIPCODE TO CARRIER LOCALITY FILE (see files below) See Related Links below for information about each specific fee schedule. CMS develops fee schedules for physicians, ambulance services, clinical laboratory services, and durable medical equipment, prosthetics, orthotics, and supplies. This comprehensive listing of fee maximums is used to reimburse a physician and/or other providers on a fee-for-service basis. A fee schedule is a complete listing of fees used by Medicare to pay doctors or other providers/suppliers.
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