Blog

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 […]

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The impact of proposed bad debt changes Overview In February, the Department of Health and Human Services (HHS) released its FY 2019 President’s proposed budget, Putting America’s Health First. DataGen analyzed of the potential impacts of some components of this budget. One area that caught our attention was how the proposed budget affects bad debt […]

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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 […]

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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, […]

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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 […]

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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 […]

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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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