Prospective Bundling

Global’s bundled payment technology provides the solution for prospective bundled payments (see chart below).

The system is flexible enough to maintain a variety of bundled payment contract rates, targets and payment rules. Upon receipt of electronically generated claim files, from any provider and for any bundled episode, the system automatically bundles them into pre-identified unique cases based on those rules. Through automation, projected payments (costs to the bundle) are calculated.  Upon receipt of electronic remittance of bundled payments from payers, underlying claims from providers are auto-adjudicated. Then the system can either perform complete payment services or generate electronic remittance information to providers (unbundled) as well as ACH information to banking/accounting systems for payment.

The system further provides real-time financial analytics on net margin per case or cumulative profit/(loss) per contract or client group. Currently, most hospitals, healthcare systems, fiscal intermediaries, clearinghouses and banks lack the systems to process real-time financial transactions under bundled payment arrangements. This means that the financial reporting to properly manage prospective bundled payment risk is severely limited.

If you need help with analysis, design, implementation or administration of a prospective bundle payment program, we are the experts.

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