Blog

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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In an effort to balance funding distribution for Medicare Disproportionate Share Hospital (DSH) payments, the Centers for Medicare and Medicaid Services (CMS) is phasing in a changed approach to allocating those funds. Based around the S-10 worksheet, a tool used by hospitals to report charity care and non- Medicare bad debt expenses and collect uncompensated […]

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On Friday, July 14, the Centers for Medicare and Medicaid Services (CMS) released the 2018 Outpatient Prospective Payment System (OPPS) proposed rule. While some of the contents aren’t surprising, there is a key issue at stake that could fundamentally alter the way the Comprehensive Care for Joint Replacement (CJR) bundled payment model functions. The proposed […]

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What can you do while CMS decides how to handle the mandatory program? As the healthcare community continues its march away from fee-for-service models, bundled payment initiatives have risen in popularity—thanks in no small part to their ability to fuel cost savings and significantly improve care outcomes. The Centers for Medicare and Medicaid Services (CMS) […]

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Another round of major healthcare financial cuts is possible—and their impact could be devastating. As healthcare policymakers and analysts try to mitigate the high cost of healthcare in the United States, payment reform is already making an impact on the way provider organizations do business. DataGen recently released projections revealing the impact of cuts made […]

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