BPCI Advanced

Claims Completion and Lag in Bundled Payment Episodes

Submitted by jonpearce on Wed, 2019-03-06 10:32

Participants in Medicare bundled payment programs want to know when an episode’s claims are “complete”, at which point the episode’s cost can be compared to the target price. Estimating the "claim lag" and completion rates, however, are hampered by the amount of variability in claims payment across episode types and individual episodes. This article will explore those issues and suggest a point at which such estimates can be made.

Choosing BPCI Advanced Episodes for the August 1 Deadline

Submitted by jonpearce on Sun, 2018-07-15 19:40

CMS provided BPCI Advanced applicants with an unexpected gift in early July when they announced a "no harm, no foul" bailout opportunity for all participants occurring in March 2019. At that point, participants can retroactively terminate participation in any or all BPCI Advanced episodes, with no financial risk. This gives participants an additional eight months past the August 1 application deadline to evaluate opportunities in various selected episodes.

Evaluating BPCI Advanced Target Factors in Episode Selection

Submitted by jonpearce on Sun, 2018-07-08 19:49

Along with the BPCI Advanced claims data, CMS provided to applicants with an Excel workbook named 2018_05_31_bpid-0000_Baseline_MY_1_2_Prelim_TP.xlsx containing the preliminary targets for all episode types in which the hospital had sufficient baseline episode volume. Those workbooks also contained the three factors that are used to adjust each hospital's baseline cost to compute the final target amount.