MBC’s Best Billing Practices For Bundled Payment Models in Texas

Medicalbillersandcoders.com experts have witnessed a sudden rush in Texas for billing professionals, triggered as much by concern as also in a panic about - how to transition to the innovative payment model like bundled payment platform which is gradually replacing the traditional pay-per-service.

MBC realizes that there is a lack of understanding among providers in Texas about the intricacies of bundled payments. Health authorities have proposed four bundled payment models as part of their Bundled Payment for Care Improvement initiative and are currently testing them out in participation with care providers-

• Retrospective Acute Care Hospital Stay Only – involves inpatient stay in acute care hospital, for which the hospital will be paid a discounted amount according to rates mentioned in Inpatient Prospective Payment System
• Retrospective Acute Care Hospital Stay plus Post-Acute Care – covers auxiliary services related to an inpatient stay
• Retrospective Post-Acute Care Only – covers post-care services given by facilities accredited skills to render such services, like nursing homes, rehabilitation centers
• Acute Care Hospital Stay Only – involves a single amount prospectively determined for hospitals which would encompass payment for all services provided during inpatient stay

Bundled payment, as the name implies is a single payment for various services provided for a particular treatment, which may include several providers in varied settings. MBC understands the dynamics associated with these payments and have been assisting providers in Texas to prepare themselves accordingly.

MBC’s experts while assisting providers in Texas perceived certain benefits linked with bundled payments, like - improved coordination between the various care providers involved, flexibility to support the method and place where certain care is delivered, simplified billing with only one bill instead of multiple ones and finally providing accountability of care for specified treatment.

However, MBC has also seen care providers in Texas face challenges like-

• Identifying the care services falling within and outside an episode
• Limited number of patients from one area if adoption of care is not widespread
• Need to avoid high-risk patients or those treatments that might surpass average episode payments

Additionally MBC witnessed with the bundled payment model a lack of motivation amongst care providers to reduce unnecessary episodes.
Read More : Texas Medical Billing

MBC helps physicians in Texas handle bundled payment models-

“I am not sure whether innovative payment modules are good or bad for me, but what’s clear is by the time I understand them properly I will have already incurred some losses,” rued a mid-sized medical practitioner in Texas.

Empathizing with this concern MBC‘s experts have the capability to provide a holistic approach to equip care providers to meet the various challenges associated with bundled payment model. Through its comprehensive Revenue Cycle Management services, MBC has helped various care providers in Texas to easily adapt to it by improving their internal operations by -

• Performing a thorough assessment of their revenue cycle
• Spotting gaps that fatten and slow down operations
• Tweaking existing software applications to meet reform needs more effectively and replacing them with new applications where required
• Identifying areas of training and training their staff

MBC team works towards helping care providers overcome the service-identification challenge helping to understand the start and end points of care services within an episode as also to identify the care services that form the part of an episode and ones that don’t. These activities plus assistance on negotiating schedules and payer contracts have helped care providers in Texas to effectively work with innovative payment models like bundled payments.

The healthcare landscape in Texas is made of big, small and medium-sized players with a thick and, in some cases, sole presence of small to medium-sized players; where MBC has been providing end-to-end billing and coding services along with guidance on easy adaptation of innovative payment models.