MedPAC mulls bundled payments, changes to therapy cap exceptions process

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Nursing homes will be subject to escrow for all civil monetary penalties, CMS announces
Nursing homes will be subject to escrow for all civil monetary penalties, CMS announces

The bundling of payments to post-acute providers and an overhaul of the therapy caps exception process were just two of the Medicare changes that the Medicare Payment Advisory Commission (MedPAC) floated last week.

Bundling Medicare payments to skilled nursing facilities and other post-acute providers has the potential to encourage more efficient coordination of care, and discourage high volumes of service, according to MedPAC members Carol Carter and Craig Lisk. But, they say, questions remain, such as whether there should be separate bundles for hospitals and other post-acute providers, or whether all payments should be combined into one.

As for Medicare's $5.3 billion outpatient therapy benefit, MedPAC members agreed that much more analysis is necessary before recommending any permanent changes. One suggested change could be requiring stronger “physician attestations” on reimbursement claims. Another possibility is overhauling the payment system. Changes could include requiring submitted claims to have clear and specific diagnosis codes, and more information on the need to exceed therapy caps.

MedPAC is an advisory body to Congress that issues formal recommendations twice yearly. Congress is free to ignore or take up the panel's recommendations. Click here for more information on MedPAC's discussions on payment bundling, and here for more on Medicare's outpatient therapy benefit.

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