Blog

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 […]

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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 […]

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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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