Jonathan W. Pearce, CPA, FHFMA

Introduction

In July 2016 CMS released a Notice of Proposed Rulemaking (NPRM) of its intent to implement a mandatory bundled payment program for specified cardiology and cardiac surgery services, along with several other programs. These Episode Payment Models (EPMs) will begin in July 2017 for almost all hospitals located in 98 selected metropolitan statistical areas (MSAs).

About 800 hospitals are staring down the barrel of the Medicare Comprehensive Care for Joint Replacement (CJR) payment program, which will be implemented on April 1. Those hospitals that have gone through the somewhat-arduous process of signing up to receive their claims data and downloading it from the CMS portal now have the opportunity to use that data to begin to understand their CJR episodes of care and to design a strategy for success under the program. The steps below outline the beginning of a data-driven strategy for CJR.

BPCI participants who started in April 2015 are now eagerly awaiting their first reconciliation, which is scheduled to be released by January 1. Here's an overview of what you'll get with that first reconciliation.