Bundled Payment Initiative by HHS

Posted by Ecareindia on July 2nd, 2013

The recent buzz in the healthcare domain is about the CMS’s latest announcement on the Bundled Payment initiative. On Jan 31, 2013, the Centre for Medicare & Medicaid Services has proclaimed that more than 500 healthcare organizations are participating in this initiative. The main motive of this initiative program is to improve the quality of patient care while reducing the costs to Medicare. While patients enjoy great benefits out of this program, providers are left to struggle adapting to the new payment method and balancing their healthcare revenue cycle management. Let’s do a more detailed study:

An Old and Effective Design: Like many of us believe,the Bundled Payment model is not a fresh idea. Its pilot was already demonstrated in the 90s by the CMS. Named as the Medicare’s Heart Bypass Center Demonstration, this pilot had attained a certain level of success, giving a new ray of hope to the present world. Medicare was able to save approximately $42 million and patients up to $8 million.

Classification:
1. Retrospective Acute Care Hospital Stay Only: Healthcare providers who participate in this scheme will be paid by the Medicare’s fee-for-service system as they don’t have any predetermined target price. However, they will have to adopt new medical billing practices, which might affect the healthcare revenue cycle management badly.

2. Retrospective Acute Care Hospital Stay Plus Post Acute Care: In this model, Providers are expected to set a target price, which will be paid by the Medicare at the end of each episode based on a retrospective study. In case the cumulative FFS payments exceed the target price, then the Provider must repay Medicare. Conversely, if they are less, the Provider will be paid the difference.

3. Retrospective Post-Acute Care Only: Similar to the 2^nd model, this scheme allows Providers who participate in it to choose up to 48 medical condition varieties. While they already suffer a 2% HHS sequestration cut on provider payments, Bundled Payments have worsened the situation, affecting the normal physician billing practices.

4. Prospective Acute Care Hospital Stay Only: For all services rendered during an inpatient stay, Medicare will pay the Provider a single, prospectively determined payment.

Apart from Healthcare Providers and Facilities, US based medical billing companies also find it difficult in adapting to the Bundled Payment method. After all, the US based physician billing companies have to bear the brunt when their clients go through a struggle. Instead of spending on staff training, technology up-gradation and more, US based medical billing companies can outsource Bundled Payment services to an experienced offshore company like e-Care.

About e-Care India:
e-Care India is one of the renowned medical billing outsourcing companies in India that promises the above mentioned benefits with total customer satisfaction. With 13 years of experience in the industry, e-Care’s offshore medical billing delivery centers have been providing end-to-end medical billing services seamlessly to its clients, namely the US based physician billing companies. To know more about e-Care and its services, log on to www.ecareindia.com