Government Mandated Healthcare Payment Reform is Coming
T
he Centers for Medicare & Medicaid Services (CMS) is effectively implementing a strategy to shift Medicare Fee-for-Service (FFS) payments to alternative reimbursement models. CMS proposed the first mandatory bundled payment model, i.e. the Comprehensive Care for Joint Replacement Model (CCJR), in July as a 5-Year Program CY2016-2020.
CCJR covers Fee-for-Service Medicare beneficiaries discharged under MS-DRG 469 and 470 (Lower Extremity Joint Replacement (LEJR) procedures). The proposed bundle will cover all related Medicare Part A and Part B services across the episode of care, which CMS defines as beginning at inpatient admission through 90 days post-discharge.
