Industry Insights

CMS has recently proposed to remove total knee arthroplasty (TKA) surgical procedures from the Medicare "inpatient-only" list, which would allow those procedures to be performed on an outpatient basis.

In our previous article on this topic we suggested that participants in the CJR program shouldn’t expect the amounts in their initial Performance Year 1 (PY1) reconciliation to be final, and should instead expect their NPRAs to decrease in the final reconciliation that will occur in 2018. This is because claims will continue to be processed until the final reconciliation, so episode costs will increase while targets will remain constant.