The visits must each appear on a separate claim form to ensure full APG payment. Otherwise, a discounting policy will take effect and APG payments will be reduced. The capability to submit each separate hospital-based clinic visit on its own claim is a special Iowa Medicaid provision which partially offsets the effects of discounting. The software has been modified to handle this provision. With the ability to automatically classify outpatient medical codes under appropriate APGs, Mercy is better able to ascertain which APGs are relevant.
Payment depends on how the various groups of APGs occur together on the case.
According to medical records staff, the hospital is better able to focus on outpatient costs as well as develop clinical protocols. Although Mercy Hospital recently began developing clinical protocols to suggest diagnostic and treatment approaches, APGs already help staff see where protocols could improve care and contain costs. It can be used for staff training and case evaluation by hospitals in any state.