Course | Basic | Medicare Payment and Reimbursement
In this course we will address scheduling processes, including<div><ul><li>Patient identification</li><li>Requested service</li><li>Medical necessity screening</li><li>Medicare Advance Beneficiary Notice of Noncoverage processing</li><li>Pa...
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Course | Overview | Medicare Payment and Reimbursement
This course provides a brief history and overview of Medicare and Medicaid. It describes government organizations that regulate and administer this program. This course also discusses Medicare reimbursement. In addition, it highlights recen...
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Course | Intermediate | Medicare Payment and Reimbursement
This course provides an overview of the prospective payment systems used in the Medicare program and as well as Medicare fee schedules. This course provides a general discussion and overview of Medicare reimbursement under the Inpatient Pro...
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Course | Intermediate | Medicare Payment and Reimbursement
This course provides a general discussion and overview of reimbursement provided by Medicare under the outpatient prospective payment system. It also discusses the use of ambulatory payment classifications in the outpatient prospective paym...
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On Demand Webinar | Intermediate | Medicare Payment and Reimbursement
As the senior population continues to outpace the relative growth of the general population, and Medicare Advantage is accounting for about one-third (and growing every year) of all new Medicare eligible enrollees, providers are increasingl...
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Comment Letter | Medicare Payment and Reimbursement

HFMA Comments on CMS’s EPM IFR

Comment Letter | Medicare Payment and Reimbursement

HFMA Comments on CMS’s EPM IFR

HFMA submitted comments to CMS on EPMs; Cardiac Rehabilitation Incentive Payment Model; and Changes to the CJR; Delay of Effective Date interim final rule 

In the letter, HFMA states that our members strongly support delaying the start of the cardiac and hip fracture episodes described in the EPM interim final rule (IFR). At this time, the bundles included in the EPM IFR do not reflect the principles HFMA has articulated for “fair and rational” payment models. In our comment letter related to the proposed rule, HFMA’s members identify specific technical design flaws with those bundles. The most significant issues identified are:

  • Lack of risk adjustment
  • Insufficient episode exclusions
  • Insufficient access to Medicare claims data in a timely fashion
  • Insufficient (or inapplicable) quality measures
  • Inadequate waivers from antiquated fraud-and-abuse regulations that were designed to address the volume incentives inherent in fee-for-service-payments

As for CJR, CMS delays the effective date of finalized changes to the model to October 1, 2017. HFMA encourages CMS not to delay these changes further. These adjustments create a pathway for the CJR program to be considered an Advanced Alternative Payment Model (AAPM) under the Medicare Access and CHIP Reauthorization Act (MACRA).

Download the comment letter

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