The Centers for Medicare and Medicaid Services (CMS) announced this week that it is going to implement new, more inclusive bundled outpatient codes akin to inpatient diagnosis-related groups. The move is happening because CMS wants to better align Medicare’s payment systems, according to a recent Modern Healthcare article.
Currently, the basic payment unit is the ambulatory payment classification, or APC. When hospitals and other providers bill individual outpatient services, they are assigned to APCs. Then, hospitals and other providers are paid based on those services.
Those who are behind the new payment option say that if the (bundled) payment rate is appropriate for all itemized things on the claim, people will be more comfortable with the notion of a comprehensive APC.
However, not all provider groups are pleased with the bundled payment options. According to Pam Kassing, senior economic adviser for the American College of Radiology, two comprehensive APCs that involve a procedure to clear artery blockages represent 85 percent of all imaging services that would be packaged under the new codes.
Kassing told the news source that “there is a lot of imaging involved in those APCs,” and radiologists want to make they aren't getting shortchanged with the bundled prices.
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