Introducing APCActive Outpatient PPS (OPPS) Components
APCActive was developed in response to the implementation of the Medicare outpatient prospective payment system (OPPS). The Omnibus Budget Reconciliation Act (OBRA) of 1986 called for the development of a prospective payment system for outpatient care. The OPPS developed by CMS is the outpatient equivalent of the inpatient DRG-based PPS. The basic unit of payment in the inpatient PPS is a hospital admission while the basic unit of payment in the OPPS is an outpatient visit.
Like the inpatient system based on the Diagnosis Related Groups (DRGs), each APC has a pre-established prospective payment amount associated with it. However, unlike the inpatient system that assigns a patient to a single DRG, multiple APCs can be assigned to one outpatient record. If a patient has multiple outpatient services during a single visit, the total payment for the visit is computed as the sum of the individual payments for each service.
There are two APCActive Components:APCActive Code Editor DLL combines editing logic with the new APC assignment program designed to meet the mandated OPPS implementation. The software performs the following functions when processing a claim:
There are two types of APCActive DLLs to match your system architecture:
The following data elements must be included on a patient record to successfully be processed by the program:
|Type of bill||Service date|
|Statement covers period, from and through dates||Revenue code|
|Birth date||Service units|
|Condition codes||Medicare provider number (NPI or OSCAR)|
|HCPCS/CPT procedure code(s) and modifier(s)||ICD-10-CM diagnosis code(s)|
APCActive Outpatient PPS (OPPS) Components are an ideal solution for claims processing applications, data warehousing and data analysis, claim review, compliance auditing, repricing applications and more.
Compatible with the leading Windows development environments including:
APCActive components are licensed based upon usage.
For a single site installation, like a health plan, hospital, or university, the APCActive components are licensed for internal use based on the size of the installation.
For a Software Developer including the APCActive component in a software package for distribution to an end user, a distribution agreement is required. Terms: an initial license fee and a per-site fee for each APCActive Component.