Last week, The Centers for Medicare & Medicaid Services (CMS) released corrected Performance Year (PY) 1 final reconciliation reports and PY2 initial reconciliation reports. This action was taken after an error was detected in the application of exclusion logic for Bundled Payments for Care Improvement (BPCI) episodes during the 2018 Comprehensive Care for Joint Replacement (CJR) reconciliation processing.
While CMS believes that this error has not materially impacted every hospital’s PY1 final and PY2 initial reconciliation reports, the PY1 final reconciliation reports issued on both June 5, 2018 and June 29, 2018 and the PY2 initial reconciliation reports issued on both June 5, 2018 and June 29, 2018 have been withdrawn. Accordingly, all appeals received regarding these reconciliation reports have been dismissed.
The corrected reconciliation reports and related data files were posted to the CJR electronic funds transfer (EFT) accounts last week. Hospitals have 45 calendar days from date posted in the EFT account to appeal the new reconciliation reports. MedBen has retrieved the new files for our clients and will upload them in the MedBen Analytics Portal on Friday, August 3.
In light of these corrected reconciliation reports, clients who utilize MedBen Analytics’ CJR gainshare distribution services will receive a revised list of claim billing errors that could impact a physician’s eligibility to gainshare, or reduce the dollar amount they are able to receive. If you do not have these services, MedBen can administer the allocation of profits resulting from high-quality, cost-effective care between the hospital and its collaborators for a nominal fee.
Clients with questions regarding the PY1 and PY2 report changes are welcome to contact Cari L. Coventry, Manager of Operations for MedBen Analytics, at ccoventry@medben.com. If you’re interested in setting up gainshare calculation and distribution services or to learn more about them, please contact MedBen President & CEO Kurt Harden at 888-633-2364 or email medbenanalytics@medben.com.