5 things to know about colonoscopy payment: AGA bundle vs. Medicare model

The American Gastroenterological Association recently published a Q&A on its colonoscopy bundled framework and the current Medicare payment model for colonoscopy. Here are five things to know.

1. Medicare currently reimburses for colonoscopy based on the Medicare Physician Fee Schedule, which falls under the fee-for-service payment model. Postoperative visits are able to be reported separately.

2. CMS will likely release changes to lower endoscopy code values with its November final rule. Any changes made will go into effect in 2015.

3. The AGA released a model for bundled payments, which includes:

•    Pre-procedure period: includes physician/staff consultation and bowel preparation instruction
•    Procedure: includes fees for colonoscopy, anesthesia, facility and pathology
•    Post-procedure: communication with patient and repeat procedures if post-colonoscopy bleeding occurs or bowel prep leads to incomplete procedure

4. The bundled model aims to decrease waste, improve quality of care and promote clinical coordination.

5. There is no obligation for GI practices to take on bundled payments. The AGA recommends making the decision to adopt the bundled payment model based on patient mix, local market factors and payer receptivity.

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