What is the difference between an APC payment and a DRG payment? What is the difference to the patient?
DRG payments are made to IPPS hospitals for inpatient admissions. The DRG grouping is based on the diagnoses for which the patient is admitted. The payment amount is the same regardless of the length of the stay. Beneficiaries are responsible for the Part A inpatient hospital deductible, coinsurance or lifetime reserve copayments. APC payments are made for outpatient PPS services only. APC payment is based on the services that the beneficiary requires rather than the diagnoses. More than one APC payment may be made during one episode of care, depending on the services required. Beneficiaries are responsible for the yearly Part B deductible and any applicable copayments associated with the required services. The coinsurance or copayment for each APC assigned to the stay cannot exceed the inpatient deductible.