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 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 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 with the customer.

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