Number of payment levels cut
The APC system groups services together and pays a present average fee for that group of services, which reduces the total number of payment levels. "The principle is, the payment for a laceration is averaged across all lacerations. For instance, all laceration repairs at the simple or intermediate level are grouped into a single category," says Smith. "So the hospital payment will be the same for a 1-inch laceration as it is for a 5-inch laceration, whether it is a layered closure or not."
2. Payment rules for physician offices and hospital outpatient services will be standardized. According to HCFA, the proposed prospective payment system for outpatient services is designed to create a "level playing field" where the same payment methodology is used to reimburse for a service, regardless of where it is performed. However, the same payment rates won’t necessarily apply to different settings.
"Implementation of these proposed rules will impose on hospital outpatient services the payment rules that HCFA already applies to physician services," says Smith.
[Editor’s note: The complete regulations can be reviewed on the Federal Register Online (Sept. 8, 1998). Web site: www.nara.gov./fedreg. Informa tion also can be obtained from the American Hospital Association at www.aha.org.]
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