Physician’s Coding Strategist

HCFA creates panel on APC groups

The Health Care Financing Administration (HCFA) in Baltimore is establishing an advisory panel on ambulatory payment classification Groups (APCs), which are used in Medicare’s prospective payment system (PPS) for hospital outpatient services. The Balanced Budget Refinement Act of 1999 required that the panel be created.

The APC panel, created in adherence with the Federal Advisory Committee Act, is being established to review the clinical integrity of the APCs and their weights. The panel’s advice will be considered by HCFA as it prepares the annual proposed rule updating the outpatient PPS to be published in the spring. The final outpatient PPS update rule for the following calendar year is scheduled to be published in late fall.

The panel will also help to ensure seniors and disabled Americans receive appropriate outpatient care by making recommendations on how Medicare classifies these services when it determines payment rates under the APCs. The panel will consist of up to 15 members who must be representatives of Medicare hospitals (including Community Mental Health Centers) that are subject to the outpatient PPS.

The panel will provide technical advice and will concentrate on operational aspects of the APC system. It is not a policy-making body. The Panel must consult with entities and organizations, such as the medical device and drug industries, with expert technical knowledge of the components of the APCs.