Medicare finalizes new joint replacement hospital payment model

Originally published in the November 18, 2015 issue of MGMA’s Washington Connection
Reprinted with Permission from MGMA

The Centers for Medicare & Medicaid Services (CMS) issued a final rule implementing the Comprehensive Care for Joint Replacement (CJR) payment model for lower-extremity joint replacement (LEJR) episodes of care. The model is scheduled to start April 2016 for hospitals in 67 geographic areas. LEJR episodes will begin with a hospitalization and end 90 days-post discharge. Episodes will include Part A and B services with the exception of unrelated clinical care. Depending on the participant hospital’s quality and episode spending during a performance year, hospitals may retrospectively receive an additional payment from Medicare or be required to repay Medicare for a portion of the episode spending. All providers and suppliers will continue to be paid under the usual payment system rules and procedures of the Medicare program for services throughout a performance year. To learn more about CJR, view CMS’ fact sheet.

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