PubMed · 14144698
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L SANTOS, K CUTLAR. 1964-05-16. HOW HOSPITALS IMPLEMENT SELECTIVE MENU SYSTEMS.. https://pubmed.ncbi.nlm.nih.gov/14144698/
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Rejecting service codes on the basis that they have been unbundled has become a popular way for payers to reduce total billed charges. However, the contract between the hospital and the payer, and not Medicare or some hastily manufactured and inconsistent industry standard, controls the obligation to pay for healthcare services.
Hospitals can prepare for APC-based systems by: Paying close attention to the modifications that state payers make to Medicare's APC policies. Proactively monitoring and adjusting billing practices to be as consistent with the state payers' APC billing requirements as possible, even if the billing requirements have no effect on current payments for services. Analyzing the ways in which state payer APC policies vary from Medicare to anticipate the impact of these systems on their hospitals' operations and financial condition.
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