LA Hospital Inform -Quality definitions
 

Definitions
Outpatient Services

All information in this report is taken from the Medicare Outpatient Prospective Payment System (OPPS) Identifiable file which is updated annually by the Centers for Medicare and Medicaid Services (CMS), the federal organization that oversees the programs.  The file includes billing data for 100% of all Medicare fee-for-service claims for hospital outpatient services during the twelve months ending December 31.  The report is based on the most recent period available and is consistent with CMS Data Release policies.

The Medicare program groups many hospital outpatient services into Ambulatory Payment Classifictions (APCs) for payment. Our report is based on APCs, but uses modified descriptions to make them easier to read and understand. APCs with the largest numbers of claims (as ranked by volume for Louisiana hospitals) are reported. (APCs for common laboratory tests and generalized categories are excluded because they do not lend themselves to comparative reporting among hospitals.):

  • Categories - the most frequent APCs are categorized for review.  These categories are unique to this website.
  • Description - simplified descriptions are used instead of the technical terminology associated with APCs.  APC numbers are also included within parentheses as part of the description.
  • Units - the units of service provided to Medicare outpatients in the APC category for the 12 month period being reported.
  • Charge Range - Average hospital charges for an APC are reported as the "Higher" and "Lower" ends of the range representing about 68% of all patients.  (Statistically, this is referred to as +/- one standard deviation from the mean.) PLEASE NOTE: In some situations (e.g. when there are only a small number of patients in an APC) a blank will appear if it is not possible to calculate a reasonable "Lower" end.

IT IS IMPORTANT TO REMEMBER THAT ACTUAL PAYMENTS TO THE HOSPITAL MAY DIFFER SIGNIFICANTLY FROM CHARGES.  THE MEDICARE PROGRAM MAKES FIXED PAYMENTS FOR APC'S REGARDLESS OF A HOSPITAL'S CHARGES AND INSURANCE COMPANIES MAY NEGOTIATE DISCOUNTED PAYMENT ARRANGEMENTS.

 


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