Long-Term Care

Bundled Payments: Final Hip and Knee Rule by Reg Hislop III

MDS 3.0 Insider, December 4, 2015

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On November 16, CMS issued the final rule for bundled payment demonstration (lower extremity) effective April 1, 2016. A single payment, made to a qualifying hospital in one of 67 regions/MSAs covers all aspects of the hospital care, the surgery, and any post-discharge, post-acute stay components through 90 days (from initial hospitalization). The payment exclusions include unrelated hospital and Part B costs, unrelated acute and chronic DRGs and drugs outside the episode (e.g., clotting factors, etc.). The original proposal known as CCJR (Comprehensive Care for Joint Replacement) included 75 regions/MSAs. The final rule whittled the total to 67 excluding regions such as Colorado Springs, Richmond, VA, and Las Vegas.


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