Healthcare Innovation Pavilion: Bundled Payment Program - Payer Perspectives – Think Like A Payer As You Build and Negotiate
(Room Hall CD, Booth #857)
10 Oct 17
11:45 AM
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12:15 PM
Tracks:
Healthcare Innovations Pavilion
As your organization prepares to build and negotiate its bundled payment programs for high cost procedures with payers, it is important to understand in advance how a payers will view and administer this concept and what risks your practice may be taking, regardless of whether you are the bundler or one of the providers contracted with the bundler.. The “bundler” might be a practice, ASC, hospital or other entity, and the payer will have criteria that have to be met as the contract terms are negotiated. Among other details, this session will cover the administrative challenges in claims processing of a single reimbursement amount for all expenses related to a spectrum of services rendered by providers that may have different TINs and NPIs, that are corralled together by the bundler. Agreements with payers will need to define what services are included – examples: pre-admission testing, diagnostics, surgeon, anesthesia, facility (ASC, Hospital, Rehab), PT, Re-admissions, etc….and over what timeline, with some “what if” scenarios. The session will also cover some practical issues related to risk management, including the controversial topic of which patients are eligible for the bundled program, how this selection process would work with regard to communication among the bundler, the associated providers, the payer and the patient. And we’ll cover much more….. all intended to put your organization at the forefront of implementing this concept successfully.