New Bundled Payment System For Cardiology Will Shift The Power From Hospitals

1
New Bundled Payment System For Cardiology Will
Shift The Power From Hospitals To Physicians

• Medical Billers and Coders

2
Health insurance plans and the new bundled
payment systems for physical treatments including
cardiovascular procedures shift from time to
time. This scenario has presented hospitals and
physicians to rethink their strategy when it
comes to proving services to an individual with
cardiology issues. The medical billers and coders
who work on such claims need to verify it not
once, but two to three times as it needs to be
crystal clear as to where most of the
reimbursement is getting drained or why is there
a delay in payment posting. Encounter-based,
bundled repayments have now appeared at the
forefront of the national discussion on combating
rising health care costs. The most preferred,
fee-for-service model for reimbursement,
hospitals, physicians, and post-acute care
providers file distinct claims and are paid
separately for provided services even when they
are related to a single encounter of care.
3
But, but, but. Theres a catch to this approach
of payment as it encourages fragmented care, with
little incentive for resource stewardship,
coordination, or communication across multiple
providers. On the contrary, bundled payments seek
to align the interests of providers by as long as
a fixed payment for all services delivered during
a single episode of care this payment is
distributed among all providers in a health care
system involved with that patient, including
hospitals and other facilities. The medical
billing team should also remember that although
not a new policy initiative, bundled payments
have resurfaced in the current era of health care
reform with its advocates arguing that it can
curtail health care costs while simultaneously
improving quality.
4

• Cardiology Payments
• Cardiology procedure and care is the area in
  which the implementation of bundled payments is
  arguably most visible and maybe most impactful.
  Many of the previous demonstrations of bundled
  payments have concentrated on and around
  cardiovascular conditions, and going forward it
  is likely that future efforts will continue to do
  so with good reason.
• Firstly, cardiology issues are common, costly,
  and deadly, and therefore, important to national
  discussions for health care reform.
• Secondly, care for cardiology procedures involves
  multiple provider chains ranging from different
  disciplines that include primary care, cardiac
  surgery, anesthesiology, and radiology.
• Lastly, cardiology patients can receive care in
  multiple health care settings such as hospitals,
  outpatient and primary care facilities,
  subspecialty clinics, skilled nursing facilities,
  solo physician facilities, etc.

5
Given all reasoning of the above factors, bundled
payments have the potential to substantially
improve care coordination and generate savings
for cardiovascular care, but in the end, it also
gives more payment options to physicians rather
than hospitals.
6

• To Present The New Bundle Payment Scheme In
  Simple Words
• Bundled payments are a middle ground in the
  spectrum of health care payment models. On one
  side they are considered as a shift from the
  traditional fee-for-service model, where
  providers are reimbursed separately for each
  distinct service provided. However, bundled
  payments are not representative of global
  payments, or capitation, where a health care
  system is paid a lump-sum payment per attributed
  patient over a distinct time period, regardless
  of the number of distinct episodes of care.

7

• Get in Touch
• info_at_medicalbillersandcoders.com
• 888-357-3226

8

• Additionally, payments are intended to encompass
  care across multiple cardiology conditions that a
  patient may require while each individual
  encounter of care is distinct and reimbursed
  separately in a bundled payment model.
• In this scenario, there are other alternative
  payment and delivery system reforms that fit
  between the extremes of fee-for-service and
  global payments on the spectrum of health care
  payment. These include value-based payments,
  where health systems or providers are given
  additional payments for high-quality care or
  levied financial penalties for poor quality care,
  and accountable care organizations where certain
  services or conditions may be covered in a
  capitated model, but other ancillary services may
  still be provided under fee-for-service.