びびなび : ワシントンDC : (アメリカ合衆国) Washington DC

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*In The Know with BPCI Advanced*






*June 26, 2024*




*Issue No. 50*






*Table of Contents*
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*

Transitioning to Value Based Care [ #tra ]

 


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Medicare Claims in Value-Based Care [ #und ]

 


* Stay in Touch [ #stay ]



*Transforming Episode Accountability Model (TEAM)*
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The comment period for the Transforming Episode Accountability Model (TEAM) closed on June 10. We thank all who reviewed the proposed policies included in the TEAM model. As a reminder, the proposed mandatory Transforming Episode Accountability Model (TEAM) would advance the Innovation Center’s prior work on episode-based alternative payment models, including the Bundled Payments for Care Improvement Advanced (BPCI Advanced) and Comprehensive Care for Joint Replacement (CJR) Models.






The proposed model would launch on January 1, 2026, and run for five years, ending on December 31, 2030. To find out more about TEAM, please see this Fact Sheet [ https://www.cms.gov/files/document/team-model-fs.pdf ].

*Understanding Medicare Claims in BPCI Advanced*
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Whether you're a seasoned veteran in value-based care or still navigating the intricacies of how Medicare claims are billed in models like BPCI Advanced, it may be helpful to revisit this process and refresh your understanding.

BPCI Advanced groups payments for multiple services during a patient’s episode of care into a single bundled payment. This approach encourages participants to deliver coordinated, high-quality care while controlling costs. Claims for services provided during a patient’s episode of care are submitted to Medicare as usual through billing called “Fee For Service”.

BPCI Advanced establishes target prices for different episodes of care based on historical data and other factors.

After the episode of care, CMS reconciles the total Medicare payments for the episode with the target price. If the total cost is below the target price, participants may receive a portion of the savings. If the cost exceeds the target, participants may have to repay a portion to Medicare.

Because the total cost of an episode is calculated based on the Fee for Service claims the provider submits, effective management of Medicare claims is crucial for participants in BPCI Advanced. Additionally, Medicare claims data is used to assess the quality of care provided during the episode. Providers are required to report specific quality measures, which impact the final reconciliation and potential payment adjustments.

Effective management of Medicare claims is crucial for participants in BPCI Advanced. Therefore, in addition to care activities like patient centered care and care coordination, BPCI Advanced providers should ensure accurate coding and timely claims submission to optimize financial performance under the model.






*BPCI Advanced Website*

Main Page [ https://innovation.cms.gov/innovation-models/bpci-advanced ] | Applicant Resources [ https://innovation.cms.gov/innovation-models/bpci-advanced/applicant-resources ] | Participant Resources [ https://innovation.cms.gov/innovation-models/bpci-advanced/participant-resources ] | Quality Measures [ https://innovation.cms.gov/innovation-models/bpci-advanced/quality-measures ]

If you have questions about BPCI Advanced, reach out to the Model Team Helpdesk at *BPCIAdvanced@cms.hhs.gov* <BPCIAdvanced@cms.hhs.gov>.

Please do not respond directly to this message as the CMS Listserv inbox is not monitored.

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