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Hy everyone! Anna here with The Coding Guild! Today we are going to talk about the Ambulatory Payment Classification system; its inner logic, how its built and why Medicare is using it for outpatient facility reimbursement. First of all, what are APCs? Ambulatory Payment Classifications, or APCs, are part of the outpatient prospective payment system concept. This is what Medicare is using to reimburse OPPS hospitals for their ambulatory facility charges. Meaning, the infrastructure, tools, room and board, drugs, needles, scalpels, anything you can imagine. In order to keep costs down, Medicare steered away from paying facilities for their itemized charges and rather created a prospective payment system where they, Medicare dictate prices. In this method, most components of a service are packaged together and paid with one lump sum for everything. If you are familiar with MS-DRGs for inpatient services, this is very similar, but for outpatient facility
