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Politics and Legislation
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Emerging Environment
Buzz words in the emerging healthcare environment. Which one is going to have the most dramatic effect on health care since the development of DRG’s? APCs, short for ambulatory payment classifications. These classifications group similar procedures and encounters into a set of codes used to apply for a reimbursement that is a predefined payment amount that the billing facility receives. How APCs will be unique is that the ICD-9 and CPT codes that a facility bills for, from the nursing record, must coincide with the documentation from the physicians record. Failure to correspond will result in payment denial, or down coding.
Today’s healthcare industry’s ever changing rules and regulations pertaining to reimbursement are leading to tighter margins, tougher compliance regulations, denied reimbursement, increase financial and medical-legal liability, increased documentation requirements, and stressed professional and ancillary staff relationships. These progressively complex rules for reimbursement, while developed to ferret out fraud and abuse, have begun to take on the appearance of the U.S. Tax Code. Additionally, the odds of a HCFA/OIG audit have become probable than a lunch visit from the IRS.
To be successful in today's emerging practice environment the old means of practicing emergency medicine has to be reevaluated. No longer is it possible to simply go to work, go home, and receive adequate compensation for the level of services that you provide. Today's emergency professional must become knowledgeable in the business and legislative issues concerning the practice of emergency medicine.
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Revised: February 27, 2003
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