medicare reimbursement

Generating revenue potential within the new models of Medicare reimbursement.

The Bundled Payments for Care Improvement (BPCI) initiative is changing the way healthcare organizations qualify for Medicare reimbursement – and helping to transform the healthcare industry as a whole.

Introduced by the Centers for Medicare & Medicaid Services (CMS) in 2013, the bundled payment program provides Medicare reimbursement based on the quality of care that providers furnish to patients, rather than the volume of services delivered. This new CMS bundled payment model is designed to increase collaboration, care coordination and communication among providers, especially in the post-acute care setting, ultimately improving patient outcomes, reducing waste and lowering the overall cost of providing care.

Qualifying for Medicare reimbursement under the bundled payment system requires expertise and technology resources that many healthcare organizations don’t necessarily have on staff or in-house. To support their efforts, hospitals and health systems can choose to work with a convener – an organization qualified to provide the capabilities and expertise required to better manage episodes of care while sharing risk with their provider partners.

When seeking a convener to help navigate this fundamental change in Medicare reimbursement, more organizations today turn to services and solutions from naviHealth.

Solutions for managing Medicare reimbursement for naviHealth.

A pioneer in care transitions and a leader in post-acute care management, naviHealth is also the nation’s largest convener for health systems seeking Medicare reimbursements under the new value-driven payment models. Our high-tech, high touch solutions are helping more than 50 hospitals today to improve the outcomes of roughly 40,000 episodes of care annually.

To help healthcare organizations succeed under new Medicare reimbursement rules, we offer:

  • Scalable technologies and proprietary solutions that impact key savings levers and manage healthcare bundled payments metrics such as SNF utilization, readmissions and PAC level of care.
  • Clinical support services that make 420 clinicians available to help guide patients to the most appropriate post-acute care setting.
  • Expert analysis of complex claim data sets and advanced analytics and reporting that can help to target areas for savings, increase provider engagement and benchmark performance against best practices.

The patient journey may start at the hospital, but that’s only just the beginning.

Benefits of naviHealth solutions for navigating Medicare reimbursement.

With naviHealth services and technology, healthcare organizations are better able to navigate the Medicare reimbursement process in order to:

  • Reduce post-acute costs to help generate greaterpotential savings.
  • Align physicians more effectively to improve care coordination and meet MACRA requirements.
  • Engage patients and their caregivers more easily in the recovery process.
  • Improve patient outcomes by investing in capabilities to manage care transitions more successfully.
  • Implement payment reform readiness initiatives to position their organization for the industry-wide shift to value-based care.

Learn more about Medicare reimbursement for naviHealth.


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