CMS BPCI Advanced Participation Agreement: Everything You Need to Know
The Centers for Medicare & Medicaid Services (CMS) introduced the Bundled Payments for Care Improvement (BPCI) initiative in 2013 to incentivize healthcare providers to deliver more coordinated and affordable care. Since then, the program has undergone several revisions, with the latest being the BPCI Advanced model launched in 2018. This model offers a voluntary participation option for providers to enter into payment arrangements that promote quality of care, reduce costs, and improve health outcomes for beneficiaries.
To participate in BPCI Advanced, providers must sign a participation agreement with CMS. This agreement outlines the terms and conditions of the program, including financial responsibilities, data sharing requirements, and compliance with federal regulations. In this article, we`ll provide an overview of the CMS BPCI Advanced Participation Agreement and what providers need to know about it.
Key Provisions of the CMS BPCI Advanced Participation Agreement
1. Payment Arrangements: Under BPCI Advanced, providers can participate in either retrospective bundled payment arrangements or prospective bundled payment arrangements. Retrospective arrangements involve reconciling actual costs against a target price, while prospective arrangements offer a fixed payment amount for each episode of care. The participation agreement specifies which payment arrangement the provider has chosen.
2. Quality Reporting: Providers must submit quality measures data to CMS as part of their participation in BPCI Advanced. This includes clinical and patient-reported outcomes, as well as process measures that assess the delivery of care. The participation agreement outlines the data submission requirements and the consequences of non-compliance.
3. Data Sharing: CMS provides participating providers with access to Medicare claims data related to their patients. Providers are required to ensure the confidentiality and security of this data and to use it for the sole purpose of improving care coordination and management for beneficiaries. Providers must also allow CMS to share their data with other organizations involved in care delivery.
4. Compliance: Providers must comply with federal laws and regulations governing the provision and billing of services to Medicare beneficiaries. This includes adhering to billing and coding guidelines, maintaining accurate and complete medical records, and reporting fraud and abuse.
5. Termination: Providers can terminate their participation in BPCI Advanced by providing written notice to CMS. The participation agreement specifies the conditions under which CMS can terminate the agreement, including failure to meet program requirements or engaging in fraudulent or abusive practices.
Benefits of Participating in BPCI Advanced
Participating in BPCI Advanced offers several potential benefits for providers, including:
1. Increased Revenue: Providers can receive additional payments for delivering high-quality, coordinated care that results in cost savings for Medicare.
2. Improved Patient Outcomes: By working together to coordinate care, providers can improve the health outcomes of beneficiaries and reduce the likelihood of hospital readmissions and complications.
3. Access to Data: Providers have access to Medicare claims data that can help them identify areas for improvement in care delivery and management.
4. Enhanced Collaboration: BPCI Advanced encourages providers to collaborate and communicate with each other to ensure that patients receive appropriate care at the right time.
Conclusion
The CMS BPCI Advanced Participation Agreement outlines the terms and conditions of the payment arrangement model and describes the obligations of participating providers. Providers who choose to participate in the program can potentially increase their revenue, improve patient outcomes, and enhance collaboration with other healthcare stakeholders. If you`re a healthcare provider considering participation in BPCI Advanced, be sure to carefully review the participation agreement and understand your obligations under the program.