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The Billers’ Association for Long-Term Care is a membership community created specifically for long-term care billing professionals. This national association provides members with a resource of continuously updated tools, billing-specific education, and reimbursement and regulatory guidance. Become a member today and join your long-term care billing colleagues as you navigate the evolving world of post-acute care billing.

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New voluntary bundled payment model announced

Jan 26, 2018
Billing Alert for Long-Term Care

On January 9, CMS’ Innovation Center announced the launch of a new voluntary bundled payment model called Bundled Payments for Care Improvement Advanced (BPCI Advanced). Under traditional fee-for-service payment, Medicare pays providers for each individual service they perform. Under this bundled payment model, participants can earn additional payment if all expenditures for a beneficiary’s episode of care are under a spending target that factors in quality.


Interested in learning more? The CMS Innovation Center will hold a Q&A Open Forum on Tuesday, January 30, 12 p.m.–1 p.m. EDT. This event is open to those who are interested in learning more about the model and how to apply. Please register in advance.


Items to consider include:

• The application window is short: January 11 to March 12, 2018

• After the initial application is submitted, claims data and target prices will be provided

• The program is a retrospective bundle; fee-for-service payments will continue under current methodologies for all providers (hospital, home health, skilled nursing, Part B, etc.)

• There will be a 20% stop-gain and 20% stop-loss provision to limit excessive earnings and losses

Industry expert thoughts:

“Most SNFs will not be capable of participating, though some may try to grab partners, etc. The episodes begin with hospitals and doctors and are concluded through postacute or outpatient/home programs. As there is upside and downside risk, I believe most postacute providers will shy away. SNFs already have their hands full with what is on their industry and policy plates.”

—Reg Hislop, H2 Healthcare

Click here for more information about the model and its requirements, or to download a Request for Applications (RFA) document, the application template, and the necessary attachments.


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