APCs In Depth: Understanding Comprehensive APCs

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Start Time:12:00 AM
End Time:12:00 AM
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Provided by MHA Center for Education

Date & Time

Thursday, April 13, 2017
10 - 11:30 a.m.


outpatient clinical staff, nursing staff, physicians, outpatient departmental managers, nurse auditors, ED nursing staff, provider-based clinic nursing staff, coding staff, coding, billing and claims transaction staff, internal auditing staff, financial analysts, revenue cycle specialists, compliance staff, cost accounting staff, chargemaster coordinators, cost reporting staff, other interested staff

The following program content was provided by the speaker.


Beginning 2008, the Centers for Medicare & Medicaid Services started increased bundling for ambulatory payment classifications. At first, this was simply at the procedure level generally using SI=“N” to effect the bundling. Then, Composite APCs were developed, and the evolution continued on to Comprehensive APCs or C-APCs. C-APCs represent significant bundling using the “J1” and “J2” status indicators. For 2016 and 2017, CMS has moved rapidly to increase the number of C-APCs and this trend is likely to continue. The basic philosophy is that APCs represent a prospective payment system in which there should be significant bundling similar to that found in DRGs. Historically, the precursor to APCs was ambulatory patient groups in which there was significant bundling through significant procedure consolidation. With the rapid deployment of many C-APCs, hospitals have a very difficult time assessing the financial impact that C-APCs engender.


  • review the various bundling techniques used by APCs
  • discuss the historical perspective of significant procedure consolidation found with APGs
  • explain the use of status indicators to drive the APC grouping process and thus the adjudication of claims
  • review the types of APC categories that are amenable to C-APCs
  • discuss what is bundled or not with C-APCs
  • review the potential of statistical variation within the C-APCs
  • list different scenarios for C-APCs to develop cost versus payment estimates for a given hospital
  • discuss steps that can be taken to mitigate the impact of C-APCs


  • Review of APCs
    • Development of APCs
    • Rejection of APGs
    • Bundling Under APCs
    • Technical Issues and Use of Status Indicator Codes
    • Changes Within APCs
    • Statistical Variations
  • APC Trends
    • Increased Bundling and Packaging
    • Impacts of CPT/HCPCS Changes
    • Coverage and Compliance Issues
  • Review of C-APCs
    • Criteria For Developing
    • 25 New C-APCs for 2017
    • Observation
    • Surgical
    • Airway Endoscopies
    • Upper GI Procedures
    • Urology Procedures
    • Extraocular Procedures
    • Adjudication Issues
  • Assessing the Impact of C-APCs
    • Financial Impacts
    • Coding and Billing Impacts
    • Other Operational Impacts
    • Modeling the Financial Impact of C-APCs
    • Steps to Optimize Reimbursement Under C-APCs
  • The Future for APCs


Duane C. Abbey
Abbey & Abbey Consultants, Inc.
Ames, Iowa

Duane Abbey is a management consultant and president of Abbey & Abbey Consultants, Inc., based in Ames, Iowa. For more than 20 years, Abbey & Abbey Consultants, Inc., has provided health care consulting services to hospitals, hospital systems, physicians, medical clinics and integrated delivery systems. In addition to consulting, Abbey has been an invited presenter for hospital associations, medical societies and other groups. He also has published articles and books on health care topics. Abbey earned his graduate degrees from the University of Notre Dame, in South Bend, Indiana, and Iowa State University, in Ames.