Medicare Compliance & Reimbursement
Medicare Introduces Payment Bundling For Post-Acute Care
The program is voluntary -- for now. CMS has unveiled a payment methodology home care organizations have been fearing, but it could have some upsides. As part of the Affordable Care Act, the Centers for Medicare & Medicaid Services is required to test payment bundling models. Home health agencies have worried that bundling would put hospitals in control of their Medicare payments, leaving agencies at their mercy for both referrals and payment rates. However: In its new Bundled Payments for Care Improvement initiative, CMS notes that the project will provide "traditional fee-for-service payment to all providers and suppliers." The catch: Later, those payments will be "reconciled" according to a discounted target price that the providers involved in bundling agree upon. However, if Medicare spending for a patient is actually below the target price, CMS will pay that reduction amount "to the participants to share among the participating providers," CMS notes in its fact sheet about the Bundling Payments program. Participation in this initiative is voluntary, but observers expect CMS to make payment bundling mandatory if the project is successful. The initiative includes four bundling models, two involving inpatient stays only. Model 2 covers inpatient stays plus post-acute services and Model 3 includes post-acute services only. Those services include HHA ones, CMS specifies in the fact sheet. Models 2 and 3 also could include durable medical equipment. Participants would be able to choose the episode's length, either 30 or 90 days post discharge. Timeline: The Model 1 bundling program, which applies to inpatient stays only, could begin as early as the first quarter of calendar year 2012, CMS says in its Request for Application document. Letters of intent are due Sept. 22 for Model 1 and Nov. 4 for Models 2-4. The bundling would be based on hospital DRGs, CMS explains in a release. The project aims to give providers "new incentives to coordinate care, improve the quality of care and save money for Medicare," the agency says. "Patients don't get care from just one person -- it takes a team, and this initiative will help ensure the team is working together," HHS Secretary Kathleen Sebelius says in the release. Collaboration among health care providers "is hard to achieve without a payment system that supports coordination over fragmentation," CMS Administrator Donald Berwick adds. More information is at www.innovations.cms.gov/areas-of-focus/patient-care-models/bundled-payments-for-care-improvement.html#.
Medicare Compliance & Reimbursement
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