decisionhealth Newsletters, Coder Pink Sheets - 2020 Issue 4 (April)
Getting paid: CMS proposes extension, expansion of CJR payment model
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Article Overview
This article reviews a CMS proposed rule affecting Medicare’s Comprehensive Care for Joint Replacement (CJR) model. It explains the broad structure of the proposal, why orthopedic groups are paying attention, and the main categories of program changes under consideration, including payment methodology, risk adjustment, reconciliation timing, and mandatory participation geography.
Why This Topic Matters
The proposal could affect how hospitals and other providers participating in Medicare joint replacement episodes are measured, paid, and reconciled. It is relevant for orthopedic stakeholders, hospital administrators, and coding or reimbursement professionals tracking federal payment model changes.
What You Will Learn
- What CMS is proposing for the Comprehensive Care for Joint Replacement payment model
- Which parts of the Medicare payment model are being extended or expanded
- What general reimbursement and risk-adjustment topics are addressed in the proposal
- How orthopedic stakeholders are responding to the proposed rule
Who Should Read This
- Hospital reimbursement professionals
- Orthopedic practice administrators
- Medical coders and auditors
- Healthcare compliance teams
- Policy analysts
- Physician group leaders
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