Cardiology procedure and care is the area in which the implementation of bundled payments is arguably most visible and maybe most impactful. 

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New Bundled Payment System For Cardiology Will Shift
Power From Hospitals To Physicians
Health insurance plans and the new bundled payment systems for physical treatments including
cardiovascular procedures shift from time to time. This scenario has presented hospitals and physicians to
rethink their strategy when it comes to proving services to an individual with cardiology issues. The medical
billers and coders who work on such claims need to verify it not once, but two to three times as it needs to
be crystal clear as to where most of the reimbursement is getting drained or why is there a delay in payment
posting.
Encounter-based, bundled repayments have now appeared at the forefront of the national discussion on
combating rising health care costs. The most preferred, fee-for-service model for reimbursement, hospitals,
physicians, and post-acute care providers file distinct claims and are paid separately for provided services
even when they are related to a single encounter of care.
But, but, but…. There’s a catch to this approach of payment as it encourages fragmented care, with little
incentive for resource stewardship, coordination, or communication across multiple providers. On the
contrary, bundled payments seek to align the interests of providers by as long as a fixed payment for all
services delivered during a single episode of care; this payment is distributed among all providers in a health
care system involved with that patient, including hospitals and other facilities.

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New Bundled Payment System For Cardiology Will Shift
Power From Hospitals To Physicians
The medical billing team should also remember that although not a new policy initiative, bundled payments
have resurfaced in the current era of health care reform with its advocates arguing that it can curtail health
care costs while simultaneously improving quality.
Cardiology Payments
Cardiology procedure and care is the area in which the implementation of bundled payments is arguably
most visible and maybe most impactful. Many of the previous demonstrations of bundled payments have
concentrated on and around cardiovascular conditions, and going forward it is likely that future efforts will
continue to do so with good reason.
 Firstly, cardiology issues are common, costly, and deadly, and therefore, important to national discussions
for health care reform.
 Secondly, care for cardiology procedures involves multiple provider chains ranging from different
disciplines that include primary care, cardiac surgery, anesthesiology, and radiology.
 Lastly, cardiology patients can receive care in multiple health care settings such as hospitals, outpatient
and primary care facilities, subspecialty clinics, skilled nursing facilities, solo physician facilities, etc.

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New Bundled Payment System For Cardiology Will Shift
Power From Hospitals To Physicians
Given all reasoning of the above factors, bundled payments have the potential to substantially improve care
coordination and generate savings for cardiovascular care, but in the end, it also gives more payment options
to physicians rather than hospitals.
To Present New Bundle Payment Scheme In Simple Words…
 Bundled payments are a middle ground in the spectrum of health care payment models. On one side they
are considered as a shift from the traditional fee-for-service model, where providers are reimbursed
separately for each distinct service provided. However, bundled payments are not representative of global
payments, or capitation, where a health care system is paid a lump-sum payment per attributed patient
over a distinct time period, regardless of the number of distinct episodes of care.
 Additionally, payments are intended to encompass care across multiple cardiology conditions that a
patient may require while each individual encounter of care is distinct and reimbursed separately in a
bundled payment model.

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New Bundled Payment System For Cardiology Will Shift
Power From Hospitals To Physicians
 In this scenario, there are other alternative payment and delivery system reforms that fit between the
extremes of fee-for-service and global payments on the spectrum of health care payment. These include
value-based payments, where health systems or providers are given additional payments for high-quality
care or levied financial penalties for poor quality care, and accountable care organizations where certain
services or conditions may be covered in a capitated model, but other ancillary services may still be
provided under fee-for-service.
Medical Billers and Coders is a pioneering Cardiology Billing and Coding Company. We offer
complete Cardiology Medical Billing Services in the United States for Cardiologists. Our Coders make the
Billing Process more efficient for the practice.