Ch. 3: Medicare Payments: Hospital Outpatient (p. 53)

Question 1

What are APCs?

Answer 1

Ambulatory Payment Classifications.

Each APC is similar clinically and in terms of resources required.

Sample calculation:

Total payment =
(60% labor x (relative weight 35.182 x $84.18 national conversion rate) x 1.200 hospital wage index)
+ (40% nonlabor x (relative weight 35.182 x $84.18 national conversion rate)
= $3,317.

Coinsurance =
(60% labor x $865 national coinsurance x 1.200 hospital wage index)
+ (40% nonlabor x $865 national coinsurance)
= $969.