Blog

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 […]

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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 […]

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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 […]

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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; […]

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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%) […]

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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 […]

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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 […]

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The Programmatic Answers to Look for in the BPCI Advanced Announcement Many current and potential bundled payment participants are eagerly awaiting the announcement from CMS of the “BPCI Advanced” program. CMS has planned this program for many months, but announcement of the details has apparently been stalled somewhere within the government. Many current Bundled Payments […]

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CMS issued new and revised instructions for charity care and bad debt data reported by hospitals on worksheet S-10 of the Medicare Cost Report. Proper reporting of these data is critical, as it is now used for the distribution of Medicare Disproportionate Share Hospital (DSH) funding. To help with interpretation of the changes, CMS has […]

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The first 12 months of the Center for Medicare and Medicaid Innovation’s Oncology Care Model (OCM) have been a significant learning experience for participants. Practices have had to come to grips with how different OCM is from other bundled payment models like the Comprehensive Care for Joint Replacement (CJR) or Bundled Payments for Care Improvement […]

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