CPB Certified Professional Biller Certification Practice Exam

What does the Ambulatory Payment Classification (APC) system do?

1. Calculates fees for hospital admissions

2. Determines payment for ambulance services

3. Calculates reimbursement for outpatient care based on clinical characteristics

4. Sets the prices for surgical procedures

The correct answer is: Calculates reimbursement for outpatient care based on clinical characteristics

The Ambulatory Payment Classification (APC) system is designed specifically to calculate reimbursement for outpatient services. It takes into account various clinical characteristics of the services provided, such as the type of procedure performed, the resources utilized, and the complexity of the case. This system enables healthcare providers to receive appropriate compensation for outpatient care, which is crucial for hospitals and other facilities that offer these services outside of traditional inpatient settings. In contrast, the options related to hospital admissions, ambulance services, and surgical procedure pricing do not accurately reflect the main purpose of the APC system, which focuses solely on outpatient care and its reimbursement. The APC methodology ensures clarity and efficiency in billing for services rendered in an ambulatory setting, thereby helping to streamline the outpatient revenue cycle.