Medicare Ambulatory Payment Classification (APC) System Impact Analysis

August 1, 2000 marked the implementation of the Medicare Ambulatory Payment Classification (APC) Outpatient Prospective Payment System. The Capstone team was asked by New York Presbyterian Hospital (NYPH) to research the new regulations to assist NYPH in developing a better understanding of the implications of these recent regulatory changes. In order to asses the extent of financial losses under the current NYPH billing practice, the Capstone team also conducted an audit and analysis of outpatient Medicare claims on a sample of 100 patient records representing one week of Emergency Department visits during the month of September. Lastly, the Capstone team performed a comprehensive policy and procedures review, identifying possible areas of improvement, and recommend appropriate operational modifications.