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In the Know with BPCI Advanced June 26, 2024 Edition
- [Registrant]Centers for Medicare & Medicaid Services (CMS)
- [Language]日本語
- [Location]Baltimore, MD
- Posted : 2024/06/26
- Published : 2024/06/26
- Changed : 2024/06/26
- Total View : 9 persons
- Find local business with Town Guide
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GVJCCA is working to protect the human rights of people, especially the Japanese Canadian community ! The magazine, "The Bulletin" reports our thoughts. We welcome anyone who wants to join us as a vol...
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- Spa Rirakuen, located in the Miyako Hybr...
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The concept of Spa Rirakuen is the healing of harmony of the five senses. In the calm, modern Japanese interior and quiet atmosphere, you can take a Jacuzzi and take a bedrock bath with SGE : TENFUKU-...
+1 (310) 212-6408AS-Create LLC. / spa Relaken
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We will carefully explain complex real estate transactions in Japanese. I am one of the few agents in the Inland Empire who speaks Japanese. Keller Williams is one of the few agents in the Inland Empi...
+1 (323) 687-2415KW / まつもと きみ ロサンゼルス不動産エージェント
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From the ideal wedding ceremony to sightseeing planning for your guests. ~ "Helping to create the happiest day of your life" is our pleasure ~ Let's imagine a once-in-a-lifetime wedding with no reg...
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Our state-of-the-art technology makes surgery and painless, and we also offer liposuction ! chemical peels and laser hair removal. We also deal with doctor's cosmetics ( Obagi and Latisse ). We ca...
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Weeee! Latest Sale 🎇️This week, Maruchan yakisoba noodles, eel, and natto with black vinegar sauce are perfect for summer ❗️Kuzefuku Shoten pasta sauce, okazu raayu, coarsely ground sausage, and shish...
+1 (510) 358-8960Weee!
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Honolulu Burger Company specializes in burgers made with fresh Hawaiian ingredients. The meat for our burgers comes from grass-fed livestock raised on private ranches such as Puu Waawaa Ranch on Hawa...
+1 (808) 376-0435Honolulu Burger
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- Specializing in hybrid cars ( New & Used...
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Our Costa Mesa store has a large selection of new ・ used hybrid cars, mainly Prius, in various variations. The store opened in February 2016 and is very clean. We also have a kids space so childre...
+1 (714) 592-1150Eco Drive Auto Sales & Leasing Inc (Costa Mesa Office)
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When you go fishing or surfing, don't you ever find that the stores around you are closed after lunch ? Fish Water is open for dining from 9:00am to 4:30pm, so please stop by if you are in the area ! ...
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aiTWorks helps our clients to ・ expand overseas to Hawaii
live in Hawaii. I want to live in Hawaii ! I want to move my family to Hawaii ! I want to start a company in Hawaii ! I want to esta... +1 (424) 216-2444aiTWorks
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- A Japanese-speaking general internal med...
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Our clinic was established in 2001 in Torrance, a suburb of Los Angeles, so that patients can receive medical care in Japanese. Medicine ( Primary Care, Family Practice, Internal Medicine ) & Gastroen...
+1 (310) 534-8200Osato Medical Clinic
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- ✨ Dandelion for Parents ✨ At our day-car...
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Day Care" When it comes to bilingual childcare, Dandelion Day Care ! We offer both face-to-face and online classes, allowing families to watch their children grow in the style of their choice. We h...
+1 (949) 940-6160たんぽぽクラブ
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- FLAT JP, Inc.
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We have been in business for 50 years and are now in our third generation. At Saito, we put our customers' needs first and offer plans that will satisfy them. Please feel free to contact us. ・ Free Es...
+81-90-6113-5078株式会社斉藤
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Located in the hometown of Yanase Takashi, the creator of Anpanman, this museum offers fun for children and adults alike. The simple dice-shaped Anpanman Museum at the Yanase Takashi Memorial Museum i...
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*In The Know with BPCI Advanced*
*June 26, 2024*
*Issue No. 50*
*Table of Contents*
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*
Transitioning to Value Based Care [ #tra ]
*
Medicare Claims in Value-Based Care [ #und ]
* Stay in Touch [ #stay ]
*Transforming Episode Accountability Model (TEAM)*
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The comment period for the Transforming Episode Accountability Model (TEAM) closed on June 10. We thank all who reviewed the proposed policies included in the TEAM model. As a reminder, the proposed mandatory Transforming Episode Accountability Model (TEAM) would advance the Innovation Center’s prior work on episode-based alternative payment models, including the Bundled Payments for Care Improvement Advanced (BPCI Advanced) and Comprehensive Care for Joint Replacement (CJR) Models.
The proposed model would launch on January 1, 2026, and run for five years, ending on December 31, 2030. To find out more about TEAM, please see this Fact Sheet [ https://www.cms.gov/files/document/team-model-fs.pdf ].
*Understanding Medicare Claims in BPCI Advanced*
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Whether you're a seasoned veteran in value-based care or still navigating the intricacies of how Medicare claims are billed in models like BPCI Advanced, it may be helpful to revisit this process and refresh your understanding.
BPCI Advanced groups payments for multiple services during a patient’s episode of care into a single bundled payment. This approach encourages participants to deliver coordinated, high-quality care while controlling costs. Claims for services provided during a patient’s episode of care are submitted to Medicare as usual through billing called “Fee For Service”.
BPCI Advanced establishes target prices for different episodes of care based on historical data and other factors.
After the episode of care, CMS reconciles the total Medicare payments for the episode with the target price. If the total cost is below the target price, participants may receive a portion of the savings. If the cost exceeds the target, participants may have to repay a portion to Medicare.
Because the total cost of an episode is calculated based on the Fee for Service claims the provider submits, effective management of Medicare claims is crucial for participants in BPCI Advanced. Additionally, Medicare claims data is used to assess the quality of care provided during the episode. Providers are required to report specific quality measures, which impact the final reconciliation and potential payment adjustments.
Effective management of Medicare claims is crucial for participants in BPCI Advanced. Therefore, in addition to care activities like patient centered care and care coordination, BPCI Advanced providers should ensure accurate coding and timely claims submission to optimize financial performance under the model.
*BPCI Advanced Website*
Main Page [ https://innovation.cms.gov/innovation-models/bpci-advanced ] | Applicant Resources [ https://innovation.cms.gov/innovation-models/bpci-advanced/applicant-resources ] | Participant Resources [ https://innovation.cms.gov/innovation-models/bpci-advanced/participant-resources ] | Quality Measures [ https://innovation.cms.gov/innovation-models/bpci-advanced/quality-measures ]
If you have questions about BPCI Advanced, reach out to the Model Team Helpdesk at *BPCIAdvanced@cms.hhs.gov* <BPCIAdvanced@cms.hhs.gov>.
Please do not respond directly to this message as the CMS Listserv inbox is not monitored.
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