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Fundamentals of Bundled Payments and Medical Billing

The shift to value-based care has driven public and private insurers to restructure their reimbursement models that stress responsibility for care quality and healthcare costs, along with the medical billing and coding tasks. As the fee-for-service atmosphere weakens, alternative payment models like bundled payments are assisting to define the future of revenue cycle management.

The Fundamentals

Bundled payment models are planned to pay multiple providers for coordinating the total amount of services required for a single, pre-defined episode of care. This type of model has been a popular method for embracing value-based care without fully immersing providers in downside financial risk contracts.

As with most new healthcare initiatives, many healthcare service providers are still wondering how the bundled payment arrangements works and how to the medical billing and coding team help them in such a initiatives.

What are the basics that healthcare providers need to know in bundled payments?

Under a bundled payment arrangement healthcare providers are paid a single payment for all the services performed to treat a patient undergoing a specific treatment. This is called as ‘episode of care,’ for a certain condition or care delivered within a defined period of time.

So, what can be done to improve probability under the bundled payment structure?

  • As technology progresses, the bundled payment structure can be optimally executed to ensure financial success. Healthcare organizations can control data analytics to gain insight into the cost related particulars through a safe and secure platform, helping adequately manage the revenue cycle.
  • Not that it needs to be told but providing the patient with an collaborating platform to be able to take necessary payment related action at the right time and also stay abreast with how policies can help them make a more informed decision, thereby giving the provider more information and space to enrich their healthcare experience.
  • The goal is to clear the hurdle with the bundled payment structure. And none other than a dedicated medical billing and coding team is required to take you out of the troubled waters.
  • The motivation to dispense quality service by cost-efficient means, might seem feasible but the practicality of it can be the biggest challenge to the providers. This is because they are unaware of the unforeseen and add-on expense such as patient’s reluctance to follow the protocol like the high-cost patients, which escalate the financial risk which can be eased by identifying and judiciously allocating resources to the high-risk patients. This way the budget can be minimized with careful and improved infrastructure coordination.
  • Lastly, in the fundaments of bundled payments in medical billing keep in mind that the healthcare environment is continuously evolving, and with CMS implementing transformation to make it more compassionate and affordable, what you need is the best billers and coders in the business

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