Here are six takeaways:
1. ASCs are well positioned to use bundled payment models because they provide similar procedures as hospitals at a lower cost. It’s also easier for ASCs to track expenses.
2. Bundled payments encourage patients to choose ASCs for surgeries and encourage payers to move patients to surgery centers, which could boost case volume.
3. These arrangements benefit patients by helping them avoid the co-pays, deductibles and high out-of-pocket payments linked to fee-for-service models. Bundled payments can also significantly cut costs for payers.
4. Bundled payment arrangements haven’t gained much traction in ASCs to date. They account for just 30 percent of industry-wide payments by Medicare.
5. For prospective bundled payment models, insurers pay providers a fixed amount for all services upfront, and the provider is responsible for any additional costs incurred later.
6. Under the more widely adopted retrospective model, payers and providers agree on a bundled target price, which is compared to the actual cost post-procedure. If the actual cost is greater than the target, providers receive additional reimbursement. If it’s under target, payers get back the amount they overpaid.
More articles on coding, billing and collections:
Bundling surgical care delivers promising results — But medical episodes are a different story
131 new ASC procedures may become device-intensive, if CMS approves rule: 5 things to know
How telemedicine can enhance orthopedic bundled payment plans — 5 insights
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.