Senior Services
Attention: Seniors
Medicare Has Changed Reimbursement for Outpatient Services
On August 1, 2000, Medicare introduced a new system for reimbursing hospitals for outpatient services. Medicare’s new system, called Ambulatory Payment Classifications (APC), was designed to improve hospitals’ billing efficiency and reduce Medicare spending. The new system affects only the hospital facility’s portion of the outpatient service, and will not affect your physicians’ fees.
This change affects all outpatient services except Laboratory; Physical, Occupational and Speech Therapy; Screening Mammograms; and Durable Medical Equipment.
Why the change?
As a result of the Balanced Budget Act, Medicare is
continuing to implement cuts in hospital reimbursements. Based on national,
rather than hospital-specific charges, the APC system will define the amount and
type of resources used in an outpatient situation. The APC system is similar to
Medicare’s Diagnostic Related Groups (DRGs), which were implemented to reduce
inpatient costs.
What does this new system mean to you?
When you receive outpatient
services, you are usually responsible for a coinsurance fee, for costs that
Medicare does not cover. Over time, this new system will ultimately lower the
coinsurance fee, which is why the AARP has fully supported this change in the
Medicare program. You might also notice changes in the Explanation of Benefits
statement you receive from Medicare.
Will this affect the quality of your care?
Absolutely not. As always, the
mission of Lake Hospital System is to provide the highest quality patient care
through advanced medical services and an experienced staff of skilled
physicians, nurses, and other health care professionals.
The APC system simply changes the way Medicare reimburses hospitals.
How can you ensure that your services are properly covered?
The APC
system requires specific physician orders to properly reimburse the hospital for
outpatient services. To make sure the Medicare system is effective for both the
hospital and the patient, your doctor will need to write complete and specific
orders.
How can you get more information?
To learn more about the APC system,
call Lake Hospital System’s Best of Health Line at
440-953-6000. Or, call the Medicare helpline at
1-800-MEDICARE.
This change also requires you to have a requisition for any service you are going to receive at Lake Hospital System. The requisition must include your name, the procedure or test, and the diagnosis or the reason for the test. In addition, YOUR DOCTOR MUST SIGN THE REQUISITION. Not having a properly completed requisition could delay your service or could result in your having to pay for the service.