Anesthesia Billing CMS new Bundle Payment Trial
Author : Doc Clemens
In an effort to achieve greater health care savings and quality, the Centers for Medicare & Medicaid Services (CMS), through the Center for Medicare & Medicaid Innovation (CMMI), has unveiled a trial system that allows providers to participate in bundled payments for episodes of care. A bundled payment combines payment for physician, hospital and other provider services into a single payment of a predetermined amount to cover all services furnished during a particular episode of care. Under the current fee for service system, CMS generally issues separate payments to each provider for services rendered.
The initiative includes four models; three retrospective payment bundling models and one prospective payment bundling model. As an incentive, participants may be entitled to a share of the monetary difference between the bundled payment and what would have otherwise been paid had they followed the fee-for-service system.
The three retrospective payment bundling models:
1) Acute inpatient hospital stay only where hospitals may share gains beyond the predetermined MS-DRG payment discount that accrue due to efficient or higher quality care delivery
2) Acute and post-acute setting where the episode of care is extended beyond the acute care inpatient hospitalization to include post-acute care
3) Post-acute care where the bundle does not include the acute inpatient hospital stay
The prospective payment bundling model:
4) One prospectively (determined by analyzing historical data for this episode of care and applying a discount) bundled payment to the hospital to include all likely services furnished during an acute inpatient hospital stay only