E/M Coding Alert - 2008 Issue 19
PART B PAYMENT: New CMS Pilot Program Bundles Physician's Pay With Hospital's
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Article Overview
This article covers a CMS payment demonstration focused on bundling Medicare Part A and Part B reimbursement for inpatient hospital stays. It is relevant to hospital revenue cycle staff, physician practices, coders, and reimbursement professionals who track Medicare demonstration projects, value-based purchasing initiatives, and payment policy changes affecting cardiac and orthopedic inpatient services.
Why This Topic Matters
The article highlights a Medicare payment model change that could affect how hospitals and physicians are reimbursed for selected inpatient procedures. It matters to organizations monitoring CMS demonstrations because it may influence contracting, payment allocation, and operational planning.
Article Sections
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CMS demonstration overview
Introduces the new Medicare demonstration and describes its purpose as a bundled payment approach for inpatient hospital care.
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Participating markets and selected services
Summarizes the initial geographic markets and the broad categories of inpatient surgical services targeted in the demonstration.
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Payment structure and provider implications
Discusses how the bundled payment arrangement may affect hospitals and physicians and notes potential operational and contractual considerations.
What You Will Learn
- The general purpose of the CMS demonstration project
- Which types of inpatient services are included at a high level
- The initial states involved in the pilot
- Why the payment model may matter to hospitals and physicians
- The broader reimbursement context of Medicare payment bundling
Who Should Read This
- Hospital administrators
- Physician practice managers
- Medical coders
- Billing and reimbursement professionals
- Health care compliance staff
- Revenue cycle teams
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