Mastering the Ambulatory Patient Groups system.

Abstract

Providers and payers will need to implement the Ambulatory Patient Groups (APG) system, a complex new payment mechanism for outpatient care. Because the APG system consolidates, packages, and discounts a facility's payment for outpatient services, providers might receive decreased reimbursement for services, as compared to the reimbursement received under their present outpatient payment arrangements. APGs, like DRGs, will force providers to examine their coding practices carefully to ensure that they will receive reimbursement adequate to cover their costs.