One reimbursement method that health plans can use for hospitals is the ambulatory payment classifications (APCs) method. APCs bear a resemblance to the diagnosis-related groups (DRGs) method of reimbursement. However, when comparing APCs and DRGs, one of the primary differences between the two methods is that only the APC method
A) is typically used for outpatient care
B) assigns a single code for treatment
C) applies to treatment received during an entire hospital stay
D) is considered to be a retrospective payment system

Question

Quizplus · Accepted Answer

The APC method is typically used for outpatient care, while DRGs are typically used for inpatient care. Therefore, only choice (A) is correct. Choice (B) is incorrect because both methods assign codes for treatment. Choice (C) is incorrect because both methods apply to treatment received during a hospital stay. Choice (D) is incorrect because both methods are considered prospective payment systems, meaning the reimbursement is determined before the service is provided.

One Reimbursement Method That Health Plans Can Use for Hospitals