The APC Advisory Group, Inc.

To successfully manage and thrive under the APCs, you’ll need highly experienced professionals who truly know the system inside and out.
The APC Advisory Group, Inc. is uniquely qualified to handle all of your APC requirements.

• Over 50 years collective experience in the actual development of ambulatory payment systems-unmatched by any other consulting organization in the field
• Assisted in the development of the APCs under contract with the Center for Medicare and Medicaid Services (CMS) formerly the Health Care Financing Administration (HCFA)
• Published more articles and the most definitive work on ambulatory classification systems than any other organization
• Published five nationally recognized texts on ambulatory service delivery, more than any other firm
• Implemented the APC system and preformed analysis at more than 250 hospitals
• Served as chief consultant to the Canadian Federal Government in the development of a Canadian APC – like system for outpatients
• Since the proposed APC rules on September 8, 1998, educated more than 4,000 executives, managers, physicians and payers on critical issues of the APCs
• Conducted large scale analysis to determine characteristics of high performing hospitals

APC Performance Analysis

While Congress directed that the implementation of APCs be budget neutral, each facility will experience different levels of reimbursement depending on the type
and frequency of ambulatory services offered. In order to determine how the APCs are affecting a hospital’s operations, an APC performance analysis is conducted.
This analysis is conducted utilizing the most powerful statistical program in the world – the Statistical Analysis System (SAS). SAS is used by ninety –eight (98%)
of the Fortune 500 Companies to evaluate and monitor financial and operational performance.
The analysis is conducted under the direction of Dr. Andrew Kmetic. Dr. Kmetic is a biostatistician who has performed analyses on behalf of the United States
and Canadian Governments. The Clinical review of the analysis is under the direction of Dr. Thomas Nagele, who is Board Certified in Emergency Medicine
and Family Practice. Dr. Jim Georgoulakis, who worked on the development of both the APCs and the Resource Based Relative Value Scale (RBRVS)
and has written more than 50 articles and a book on the APC has the overall responsibility for the analysis. The analysis provides the hospital with information
on the following;

• A procedure code level analysis – each procedure that the hospital performed in the entire year will be reviewed
• Procedures not assigned to an APC will be analyzed as to “why” it was not assigned to an APC
• Visit Level Analysis will consist of

o Number of APCs per visit
o Number of Procedures Per Index
o Expected APC Payment
o APC Payment
o Cost to Expected APC Payment Ratio
• APCs Accounting for the hospitals APCs
• Identification of APC “Winners”
• Identification of APC “Losers”
• Analysis of APC Pass-Through Payments
• APC Codes Monitored by CMS and or OIG
• CPT Codes Monitored by CMS and or the OIG
• Identification of records that should be reviewed because of potential over or under billing
• Special Analysis of the Emergency Department

o Comparison to National Profiles
o Number of APCs per level of Emergency Department Visit
o Number of procedures per Emergency Department
o Grouping ratio APCs to Procedures
• Trend Analysis

o Revenues
o Weighted APCs
• Comparison to National Benchmarks
• Development of the APC Case Mix Index
• Development of the APC Index