Making the Most of MSPB

You may not know about MSPB, but focusing efforts there can lead to real savings Now that bundled payment programs like the Oncology Care Model (OCM) and the Comprehensive Care for Joint Replacement (CJR) model have been in effect for some time, one factor is becoming clear: hospitals appear reluctant to participate. As of July […]

Wave of CMS Proposed and Final Rules is Here

In recent weeks, CMS has unveiled a number of final and proposed rules impacting inpatient, outpatient, and post-acute care delivery. These rules include annual updates of the Medicare fee-for-service payment rates based on regulatory changes.  In addition to the regular updates to wage indexes, marketbasket, and quality programs, the rules include the following: The Inpatient […]

Proposed Changes for PAC Settings

CMS looks to payment and program revisions—comments due to CMS In new proposed rules, the Centers for Medicare and Medicaid Services (CMS) is calling for payment and program changes for four post-acute care settings: skilled nursing facilities (SNFs), long-term care hospitals (LTCHs), inpatient rehabilitation facilities, and inpatient psychiatric facilities. In addition to the customary marketbasket […]

New IPPS Proposed Rule Released

Comments due to CMS by June 25 The Centers for Medicare and Medicaid Services (CMS) released its FFY 2019 Inpatient Prospective Payment System (IPPS) proposed payment rule. While we’re working on our in-depth analysis, a few key points and issues have already emerged in our review. The proposed rule reflects the annual updates to the Medicare […]

Understanding the BPCI Advanced Targets

In February, CMS issued preliminary target specifications for the Bundled Payments for Care Improvement (BCPI) Advanced program.  The targets in CMS bundled payment programs have progressed from straightforward, provider-specific, historical performance-based targets in original BPCI, to regional historical targets stratified by patient diagnosis in the Comprehensive Care for Joint Replacement (CJR) program, to case mix-adjusted, […]

10 Things to Know About the New BPCI Advanced Program

What you should be aware of—and what you can do now   After months of waiting, the Centers for Medicare and Medicaid Services (CMS) released its new voluntary episode model, Bundled Payments for Care Improvement Advanced (BPCI Advanced), which begins October 1, 2018. DataGen’s policy analysts are currently assessing the model as a whole. Participants—both […]

A Forced Reduction

Changes to Clinical Laboratory Medicare payments could have a major financial impact on hospitals. A series of payment adjustments enacted by Congress as part of the Protecting Access to Medicare Act of 2014 (PAMA) will change payments under the Medicare Clinical Laboratory Fee Schedule (CLFS) continuing through CY 2023. Hospital labs could see drastic cuts […]

New Changes for Readmissions

Socio-demographic adjustments to the Readmissions Reduction Program are here The cost of readmissions is a critical issue facing the healthcare industry. In 2014 alone, roughly 1.8 million readmissions cost Medicare $24 billion. The Readmissions Reduction Program (RRP) was implemented as part of the Affordable Care Act to reduce this spending to account for certain excess […]

Who Should Own Bundled Payment Episodes?

With the announcement of the next generation of Medicare bundled payment programs (“BPCI Advanced”) expected at any time, many different organizations are offering opinions about how this program will be structured and which types of providers should participate in which type of episodes. A frequent topic in this conversation is the “ownership” of the episodes; […]

CMS Further Extends Deadline for S-10 Reporting Changes to January 2

CMS has extended the window for hospitals to amend uncompensated care, bad debt, and other Worksheet S-10 reporting on their fiscal year 2014 and 2015 Medicare cost reports, from October 31 to January 2. Proper reporting of S-10 data is critical, as it is now used for the distribution of the vast majority of Medicare […]