decisionhealth Newsletters, Coder Pink Sheets - 2015 Issue 12 (December)
Getting paid: Prepare for new 2016 Medicare joint replacement bundled payment policy
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Article Overview
This article explains a CMS final rule establishing the Comprehensive Care for Joint Replacement model for lower extremity joint replacements under Medicare. It covers the program timeline, the geographic scope of participation, the types of providers impacted, and the broader payment and quality goals behind the policy. The article is relevant to hospitals, physicians, post-acute providers, and revenue cycle or coding professionals tracking Medicare episode-based payment changes.
Why This Topic Matters
The policy changes how Medicare payment is organized for a major inpatient surgical service and affects participating hospitals and affiliated providers across selected geographic areas. Understanding the scope and timing of the model helps organizations prepare operationally for bundled payment participation and related care coordination expectations.
What You Will Learn
- What the CMS joint replacement bundled payment model is designed to address
- Which provider groups and geographic areas are affected
- How the rollout timeline is structured
- Why Medicare is using episode-based payment for joint replacement care
- How the policy relates to payment and quality standardization
Who Should Read This
- Hospital administrators
- Physicians
- Post-acute care providers
- Revenue cycle professionals
- Medical coders
- Healthcare compliance staff
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