Navigating the Ambulatory Patient Groups (APGs)

New York, NY ( Pressreleasecollection ) October 2, 2009 - Finding Solutions with New York Department of Health Article 28

New York Article 28 providers are facing one of the most challenging changes to come from the New York Department of Health in recent years. New episode of care guidelines and a potential 25% cut in revenue within the first year, 50% the second year, and 75% the third year, some providers will be forced to make serious modifications to their operations as well as implementing a ironclad coding and documentation processes.

The CPC Medical Advantage

CPC Medical has been providing healthcare solutions for over a quarter century. We have the necessary experience to provide in depth benchmarking and financial analytics.

Software to the Rescue?
Well, not so fast, yes, there are some that will help guide you in the right direction and definitely make things easier on the physicians and staff but make sure you have a project lead that is guiding the process. Many of the Article 28 facilities already have existing software that can accommodate the new APGs system, however, if you don’t then it is always better to consult an outside consultant to make sure that you find the right solution for your Article 28 facility. New York is very different from other states and will require specific knowledge in the New York insurance billing guidelines.

Depending on the type of Article 28 facility this may just be the tip of the iceberg; the best solutions start with a phone call to a professional, whether it is your attorney, consultant or colleague.

Episode of Care
The most significant challenge that an Article 28 facility is faced with is the implementation of episode of care and its effect on the relationship with outside vendors starting January 1st, 2010.

An episode of care is defined as a medical visit and/or significant procedure that occurred on a single date of service and all the associated ancillary laboratory or radiology services, regardless of the provider or dates of the ancillary services. The new episode payment rate codes will permit APG billers to include a “to” and “from” date in the claim header ro reflect the episode of care as well as specific dates at the line level for each service provided as part of the episode of care. When using episode payment rate codes, APG billers must report the actual date of service for each service provided at the line level and a single claim must be filed for each separate and distinct episode of care.

There are a few exceptions to episode of care; for instance, the outside radiologist that is reading the test can bill the professional portion of radiology services. Most clinics will attempt to reach out to vendors by themselves. Clinics should treat this like any other business transaction and engage consultants to assist in the negotiation process. Because there are implied stark implications always consult a healthcare attorney as well. Some helpful tips are as follows.
• Benchmark fees
• Terms of payment (15 days, 30 days, 45 days, etc…)
• Professional component for radiology services
• Cost of money and processing

In 2008 CPC Medical doubled its consulting force to accommodate the accelerated changes within the healthcare sector. We plan to continue to expand well throughout 2009 and 2010.

As members of the HFMA and MGMA, you will always have access to the latest benchmarking data and tools. CPC offers clients a wide variety of consulting solutions, everything from job placement to complete revenue cycle management services, that encompass policy and procedure implementation, workflow formation, auditing, and short term billing and collections.

To find out how CPC Medical can help your business, contact Zachary Martinez at zmartinez@cpcdata.com or call 212-213-0877 ext. 441.

CPC Medical
242 West 36th Street
9th Floor
New York, NY 10018
t.212.213.0877
f.212.213.2139

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