Blog

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, […]

Read More...

The deadline for applications to BPCI Advanced is fast approaching. Between now and March 12, what can you do to learn and prepare? Here are three things to remember: Request all of your data. Include Raw Historical Claims Data with your request to effectively evaluate patterns and assess opportunities. Submit multiple applications. Since there is no limit, we […]

Read More...

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 […]

Read More...

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 […]

Read More...

The use of benchmark cost comparisons is common throughout healthcare. Benchmarks are used for comparisons of internal hospital costs across hospitals, for utilization rates in Accountable Care Organizations, and in many other places. The concept of the benchmark is that the hospitals whose costs or utilization are close to or below the benchmark will experience […]

Read More...

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 […]

Read More...

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; […]

Read More...

Hospitals in the Medicare Comprehensive Care for Joint Replacement (CJR) program appear to be facing an uphill battle as their targets transition from their own hospital episode baseline experience to targets based on the Medicare episode spend of all hospitals in their region. During the first two performance years of CJR, targets were primarily (66%) […]

Read More...

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 […]

Read More...

CMS’ new EPM final rule includes changes to the CJR program—changes that impact the composite quality score for CJR and demand attention now. While the changes will begin with the performance year 2 (PY2) reconciliation, performance year 1 (PY1) will be re-reconciled as well, affecting episodes from both years. There are a few points to […]

Read More...

Page 1 of 3123