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Certified Coding Associate ICD10 - Blogs Sample Questions

What are paid when a Medicare outpatient is discharged from the ER/clinic or is moved to another hospital that is not related to the initial hospital where the patient received outpatient services?

Correct Answer:
apcs.


the correct answer to the question regarding what are paid when a medicare outpatient is discharged from the er/clinic, or is moved to another hospital not related to the initial hospital where the patient received outpatient services, is apcs. apc stands for ambulatory payment classification.

apcs are used specifically for outpatient payment services within the hospital setting. the system is designed to classify outpatient services into groups that are expected to consume similar resources and have similar clinical characteristics. this method of classification helps in standardizing the payments for services, ensuring that the hospital receives a predetermined amount for the type of care provided, regardless of the actual cost incurred for individual patients.

when a medicare outpatient is either discharged from the emergency room (er) or a clinic, or if they are transferred to a different hospital that does not have any relation to the one where they initially received care, the hospital claims payments through apcs. this payment structure is applicable only to hospitals and is part of the broader medicare outpatient prospective payment system (opps), which aims to simplify the payment process and encourage more efficient management of outpatient services.

it is important to note that apc payments are distinct from other payment classifications such as diagnosis-related groups (drgs), which are used primarily for inpatient hospital services. whereas drgs cover the costs associated with an inpatient stay, apcs cover outpatient procedures and services, including everything from diagnostic tests to minor surgeries performed on an outpatient basis.

in summary, apcs facilitate the payment process for hospitals providing outpatient care to medicare patients, ensuring that facilities are compensated for the services they offer in a manner that is both standardized and reflective of the expected resource use associated with different types of outpatient care.