HLTH 385 Lecture Notes - Lecture 14: Procedure Code, Diagnosis Code, Bundled Payment
21 May 2018
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• Hospital compensation
• Separate claim form for hospitals, just as there are claim forms for physicians
o UB-04/1450
o Diagnosis codes, procedure codes
• Claim forms are done electronically
• When a physician bills a patient they can get paid for multiple procedures and
services
• When a hospital bills a patient they get paid for one overall thing based on:
Diagnosis related group (DRG)
• Certain hospitals are available for higher payments
o Ex) teaching hospitals (ones that have residents and interns) get higher
payments
• Current issues- areas for innovation
o Bundled payment for MDs and hospitals
• Would help MDs control inpatient costs
• MDs and hospitals just have to split the costs
• Would better align incentives
o Bundling of hospital and post-acute care
• Hospitals want to get patients out the door as quickly as possible
• From the hospital a patient can go:
o Home
o Home with home health care
o Skilled nursing facilities
• Length of hospital stay has decreased significantly overtime
o Ex) for heart attack admissions, the US is on the lower end of the spectrum
• Now releasing patients earlier, people that go to home healthcare or skilled
nursing facilities they go to post acute care
o Because they leave the hospital earlier, they often need more healthcare and
follow up
• In terms of payment, one scheme is Medicare pays for everything up front (rather
than hospital stay, then post acute care separately)
• people in post acute care often go through readmissions
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