The Centers for Medicare & Medicaid Services (CMS) is conducting a pilot program to test bundling payment for services that patients receive during a single episode of care, such as heart bypass surgery or a hip replacement. The Bundled Payments for Care Improvement (BPCI) program seeks to encourage doctors, hospitals, and other health care providers to work together to better coordinate care for patients.
CMS recently released guidelines for providers participating in its model 4 BPCI pilot program. The episode of care is defined as the acute care hospital stay and includes inpatient hospital services, Part B services furnished during the hospitalization, and hospital and Part B services for related readmissions.
Hospitals that participate in the model 4 initiative will receive a prospectively established bundled payment for agreed upon Medicare severity diagnosis related groups (MS-DRGs). This payment will include both the DRG payment for the hospital and a fixed amount for the Part B services anticipated to be rendered during the admission.
MLN Matters article MM8070, on which this summary is based, summarizes Medicare’s implementation of the model 4 initiative. The article addresses issues related to readmissions, claims crossover, remittance advice, claims submission, and beneficiary eligibility.
Blogger Widget
Popular Posts
-
Modifier - as the name implies a modifier will modify a service / procedure or an item under certain circumstances for appropriate reimbur...
-
An OPPS payment status indicator is assigned to every HCPCS code. The status indicator identifies whether the service described by the H...
-
Claim Adjustment Reason Codes (CARC) CO-22 or PR-22 This care may be covered by another payer per coordination of benefits. CO-19 This is...
-
This procedure is medically necessary only when it requires the professional skills of a therapist, is designed to address specific ne...
-
Definition: The “-59” modifier is used to indicate a distinct procedural service. The physician may need to indicate that a procedure or...
-
Mohs surgery, also known as chemosurgery, created by a general surgeon, Dr. Frederic E. Mohs, is performed to remove complex or ill-defi...
-
Ambulance transportation is a covered service when the patient’s condition is such that the use of any other method of transportation would...
-
AAPC’s Certified Professional Coder (CPC) credential is the gold standard for medical coding in physician office settings and held by more ...
-
This procedure may be medically necessary for training patients whose walking abilities have been impaired by neurological, muscular, o...
-
Sentinel lymph node identification and biopsy typically involves a multidisciplinary approach. A nuclear medicine procedure called lymph...