The Centers for Medicare and Medicaid Services (CMS) has released the Comprehensive Care for Joint Replacement (CJR) Performance Year 3 (PY3) Initial Reconciliation and PY2 Final Reconciliation Reports. MedBen Analytics has begun the process of auditing the Net Payment Reconciliation Amount (NPRA) for clients, and will soon make reports available via our secure online portal.
A hospital will earn a positive NPRA if the aggregate capped episode cost for PY3 (episodes ending on or before 12/31/2018) is less than the aggregate quality adjusted target price and the composite quality score was Acceptable, Good or Excellent.
As part of our services, we will also notify clients who have a finding in their reconciliation files that may merit further action on their part. If you wish to respond to CMS regarding the findings, you will need to complete and submit the Calculation Error Form (included with the report materials), accompanied by eligibility findings or other relevant information to CMS. Please note that the choice to act on the findings is entirely your decision.
MedBen Analytics clients with questions regarding the findings or submitting calculation error forms are welcome to contact Manager of Operations Cari Coventry at 800-423-3151, ext. 405 or ccoventry@medben.com.