eHANYS/Products & Services/ UDS-APC

The UDS-APC Software^TM

As part of the Balanced Budget Act of 1997, Congress passed legislation establishing Medicare’s Outpatient Prospective Payment System (OPPS). The Ambulatory Payment Classification (APC) is the new payment system and resource management tool for Medicare payers and providers. This new payment system has significantly changed how hospitals are reimbursed for outpatient services under Medicare.

The UDS-APC Software^TM, developed by HANYS Solutions, Inc., was designed specifically to help acute care facilities deal with the complexities of outpatient coding and the new reimbursement system.

The UPS-APC Software^TM assigns APCs and calculates appropriate reimbursements for all services (ambulatory surgery, emergency department services, clinic visits, radiology, ancillary services, etc.) covered by the OPPS. The reimbursement calculations include all of the appropriate bundling, discounting, packaging, and cost outlier algorithms to enable hospitals to determine the exact payment expected from Medicare and the beneficiary co-payment. UDS-APC Software^TMwill also calculate APCs for payers other than Medicare.

Features/Benefits

The system flags cases that would fail the Correct Coding Initiative (CCI) or Outpatient Code Editor (OCE). The CCI consists of more than 100,000 edits that a claim must pass prior to payment. Data can be edited and corrected before to being interfaced with the hospital billing system, thereby reducing claim rejections and optimizing cash flow.
The software allows for the creation of a database for reporting purposes. The database can then be used to track historical volumes and monitor “what if” scenarios.
UDS-APC Software^TM is fully integrated with HANYS Solutions, Inc.’s UIS Data System (UDS) that provides data abstracting and Statewide Planning and Research Cooperative System data submission.
The UDS-APC Software^TM contains a flexible import engine that allows data to be imported from the exported to admission, discharge, and transfer systems or billing. The system can interface with virtually any system.