Bundled Payment

The Centers for Medicare & Medicaid Service (CMS) Bundled Payments for Care Improvement (BPCI) initiative requires facilities to change their practices to maintain Quality care services while ensuring accurate and appropriate reimbursement.

BPCI is comprised of four broadly defined models of care, which link payments for the multiple services that beneficiaries receive during an episode of care across healthcare settings. Under this initiative, organizations enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality and more coordinated care at a lower cost to Medicare. Organizations considering participation in a bundled payment or other risk-based arrangement should assess the following:

  • Clinical capabilities
  • Capacity for risk
  • Competition
  • Business intelligence/analytics
  • Structures that align incentives across the continuum of care
  • Existing relationships/alliances
  • Technology
  • Local market dynamics
  • Risk-based contracting expertise
  • Nursing and Rehabilitation Staffing resources
  • Medicare Part A reimbursement knowledge
Prior to evaluating the above, a healthcare entity needs to assess its historical and potential Case Mix related to Length of Stay, Diagnoses and Discharge Destination.

How can Harmony Healthcare International (HHI) help?

Harmony Healthcare International (HHI) will establish a system for data collection for the patients/residents on Medicare Part A for the designated six month period. Upon completion of the data analysis, Harmony Healthcare International (HHI) will provide a written analysis and summary of the facility's:

  • Diagnostic Category Composition (%)
  • LOS by Destination
  • LOS by Category
  • LOS by ICD-10 (Top 12 by frequency)
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