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American Association of Hip and Knee Surgeons

Advocacy, Education, Research

‘Medicare’

What You Need to Know about CJR

In about one month, the Centers for Medicare and Medicaid Services (CMS) Comprehensive Care for Joint Replacement Model (CJR) will kick off. This five-year program begins on April 1, 2016. Under the CJR model, acute care hospitals in certain selected geographic areas will take on quality and payment accountability for retrospectively calculated bundled payments for LEJR episodes. CMS… Read More

AMA Encouraging Application for EHR Hardship

The AMA is encouraging ALL physicians subject to the 2015 Medicare EHR “Meaningful Use” (MU) requirements to apply for the hardship exemption. CMS has stated that it will broadly accept hardship exemptions because of the delayed publication of the program regulations. Applying for the exemption will not prevent a physician from earning an incentive. It simply protects a… Read More

PQRS Tool Makes Measure Searches Easier

CMS has launched a new PQRS web-based search tool on its website. This tool will assist eligible professionals (EPs) and PQRS group practices with easily identifying claims and registry measures that may be applicable, and help find measures that meet satisfactory reporting requirements for the 2016 PQRS program year. Users may search measure-related keywords as well as search… Read More

CMS Revises Short Stay Hospital Claims Guidelines

CMS has revised guidelines on “Reviewing Short Stay Hospital Claims for Patient Status: Admissions On or After January 1, 2016.” Starting October 1, 2015 Beneficiary and Family Centered Care Quality Improvement Organizations began conducting initial patient status reviews of claims for inpatient admissions. Under the revised exceptions policy (CMS-1633-F), which became effective January 1, 2016, for admissions not… Read More

CMS Releases 2014 National Health Expenditures

The new National Health Expenditures data shows that health care spending grew 1.2 percentage points faster than the overall economy in 2014, resulting in a 0.2 percentage-point increase in the health spending share of gross domestic product – from 17.3 percent to 17.5 percent. In the decade prior to the Affordable Care Act (2000-2009), health care spending grew… Read More

Hospital Associations Weigh in on CJR

Representatives from the American Hospital Association and the Association of American Medical Colleges provide commentary in an article published in HealthLeaders Media on the Comprehensive Care for Joint Replacement (CJR) bundled payment program. Both associations were pleased to see the changes implemented in the final rule issued by CMS last month, but agree that more improvements are necessary.… Read More

AARP Questions Medicare Hip and Knee Data

The AARP Public Policy Institute published a study, “Impact of the Medicare Hospital Readmission Reduction Program on Hospital Readmissions Following Joint Replacement Surgery” in its October issue. The instituted aimed to “determine whether readmission rates for elective knee and hip replacements decreased in the years immediately prior to CMS’ first application of the Medicare readmission reduction program fines.”… Read More

CMS Issues Final Rule for Pilot Payment Model

On Monday, the Centers for Medicare and Medicaid Services (CMS) issued the final rule for the Comprehensive Care for Joint Replacement program (CJR). Seven changes were published with the final rule including a new start date of April 1, 2016, and a reduction of the number of trial geographical areas from 75 to 67. “It will also scrap… Read More

AAHKS Replies to CMS RFI for new CMS Payment Systems

AAHKS Executive Director, Michael J. Zarski, JD filed a letter commenting on CMS’s Request for Information regarding development of the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) under the new Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). AAHKS offered the comments as the first step in anticipation of close collaboration with CMS to… Read More

CMS Reports Fraction of ICD-10 Claims Rejected

Healthcare Finance News reports that of the 10 percent of claims filed under ICD-10, only a fraction have been rejected by CMS due to coding errors. Rejections were DUE to incorrectly submitted ICD-9 codes and incomplete or incorrect information. The article points out, “Since the transition, claims are processing normally. Medicare claims take several days to be processed… Read More