Certified Inpatient Coding (CIC) Practice Exam

What is the payment system for Medicare outpatient services called?

1. MS-DRGs

2. RBRVS

3. APCs

4. CAPCs

The correct answer is: APCs

The payment system for Medicare outpatient services is referred to as Ambulatory Payment Classifications (APCs). This system categorizes outpatient services into groups, allowing Medicare to reimburse providers based on the clinical characteristics and typical resource consumption of the services rendered. Each APC has a specific payment rate that takes into account factors such as the type of service, any related procedures, and the expected costs associated with those services. APCs are significant for ensuring that outpatient care is compensated appropriately, balancing the need for access to healthcare with the control of costs. This system is designed to encourage efficiency, as providers are incentivized to deliver care within the payment rate established for each classification. In contrast, MS-DRGs (Medicare Severity Diagnosis Related Groups) specifically pertain to inpatient services, while RBRVS (Resource-Based Relative Value Scale) is primarily used for physician services. CAPCs (Comprehensive Ambulatory Payment Classifications) are related to a different framework focusing on comprehensive outpatient services, distinct from the standard APCs.