Hospital APC Payment Tools

A smart user who has access to both the CCH Reimbursement Toolkit Hospital Outpatient PPS Calculator and the MediRegs APC Grouper & Calculator in RRS/Plus has asked:
What is the difference between these 2 calculators?
I thought I’d share the summary with MediBloggers. Note that you’ll see reference here to the exciting new Coding & Audit Suites which will be available shortly.

There are 2 APC Calculators Available. Let me summarize them for you here:

The MediRegs APC Grouper & Calculator

The APC Grouper and Calculator performs provider-specific adjusted OPPS payment calculation by HCPCS, CPT or APC. This tool allows you to enter 1 to many codes, and automatically groups procedures into the appropariate Ambulatory Payment Category and flags NCCI Code pair issues, Procedure-device code crosswalking. It also performs multiple significant procedure discounting, and allows you to dial back in time and analyze payment for any provider in the U.S. This tool is available in the MediRegs Regulation and Reimbursement Suites and will be included in the top three tiered WK Coding & Audit Suites.

The CCH Outpatient Prospective Payment System Calculator

The CCH Outpatient Prospective Payment System Calculator helps you determine, to the penny, reimbursement for even complex cases. This calculator, one of the seven CCH Reimbursement Toolkit calculators includes the ability to specify beneficiary co-payment, charges for outlier eligibility and cacluation, and allows users to ask “what if” questions by varying wage index, and other key reimbursement variables. This tool is available in several CCH reimbursement product offers, and will be included in the top two tiered WK Coding & Audit Suites.

While we are on the subject, I can add some other resources that will be valuable to anyone interested in APC payments. In the new WK Coding & Audit Suite, the new Advanced Code Lookup will automatically show and link to both the APC and RVU Payment info for each HCPCS/CPT.

We also have electronic book format versions of each Hospital Outpatient PPS Proposed and Final Rule, a download center for critical data files, a special OPPS Archive collection and a Hospital Outpatient Specialist topic library including IOCE, and APC CodeBooks.