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Physician Bundle Payment Plans: Improving Claims Generation

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Physician Bundle Payment Plans: Improving Claims Generation
Healthcare is costly in general and what makes it more prone to increase in costs is that it comes in
phases: pre-hospitalization, hospitalization and post-hospitalization. To address the situation and
provide patients with an all-encompassing payment package, many payment modules have been tried
out over the years across all states of the US. But the one that has stood the test of time, in terms of
giving financial relief as well as improving quality of healthcare services is bundled payments.
Bundled payments offer the healthcare service receiver a flat price for all the services involved in a
treatment lifecycle, starting from diagnosis through surgery to post-surgery care.


Under this mode of payment, all individuals and bodies – like hospitals, doctors, etc. – involved in
providing healthcare share one fee for the entire cycle of a treatment. Such being the nature or
timeframe of the treatment required, bundled payments are usually available for ailments that require
protracted care such as diabetes or involve surgery such as hip replacement.


By offering a fee structure that’s fixed and one-time unlike the pay-per-service model, bundled
payments reduce costs and have the potential to improve the quality of healthcare services.           It
reduces incentive for the providers to provide unnecessary care for profiteering and also promotes
consistency in standard of quality and cross-service coordination within a treatment cycle or episode
by bringing all types of healthcare providers involved under a single payment roof.


However, for bundled payments to work to the benefit of all parties involved, a robust infrastructure –
both physical and nonphysical – is required. Similarly, there are ample challenges in implementing
bundled payments, like defining bundles (payments), administering payments, managing the network
of contracts and subcontracts covering and governing the relationship among the service providers
involved in a treatment lifecycle, etc.


Although some of these hurdles have to be removed by healthcare providers themselves and some
with the help of agencies outside the healthcare world, there are enough bodies within the larger span
of the healthcare industry that can gleefully and efficiently help care providers with claim
administration, a problem that most healthcare providers face and are time pressed to manage.


Medical Billers and Coders ensure definite benefits for healthcare providers through cost reduction by
nullifying the need to have dedicated staff and technologies within a healthcare body to deal with
claims, timely recovery of payments, compliance with fickle insurance rules and regulations, better
denial management, etc.
Medical Billers and Coders is a point in case which works in tandem with billers to process accurate
revenue codes on the basis of the clinical documentation maintained by the healthcare provider. By
closely monitoring all technical details involved in the process – like CCI edits, coding changes and Fee
Schedule analysis – Medial Billers and Coders working for their physicians have brought down denial
rates drastically, a significant achievement – as realizing claims is a commonly faced problem among
healthcare providers giving care through the bundled payment mode that they become reluctant to
participate in it despite the clear healthcare and financial benefits bundled payments ensure.


The benefits Medicalbillersandcoders.com brings to healthcare providers collectively contribute to cost
saving and time reduction for healthcare providers, an advantage they can divert to their core
business, healthcare, and also share to the customer.


Browse All: Physician Billing Services




Source: Medical Billing (http://www.medicalbillersandcodersblog.com/)

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Description: Healthcare is costly in general and what makes it more prone to increase in costs is that it comes in phases: pre-hospitalization, hospitalization and post-hospitalization. To address the situation and provide patients with an all-encompassing payment package, many payment modules have been tried out over the years across all states of the US.