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CMS Mandated Payment Reform is Coming…Are You Ready?

25 Sunday Oct 2015

Posted by Black Diamond Transformation in Bundled Payments, CCJR, Convergence, Digital HIT, Patient Reported Outcomes, Physician Alignment

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Bundled Payments, CCJR, Convergence, Patient Reported Outcomes, Physician Alignment, ValidCare

Government Mandated Healthcare Payment Reform is Coming

TRiding the Storm Outhe 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.

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