Here are three things to know:
1. The inpatient bundles begin at the inpatient admission for an anchor stay, while the outpatient bundles begin at the start of the outpatient procedure, or anchor procedure. Outpatient procedures qualifying as anchor procedures will be identified by HCPCS codes.
2. Clinical episodes last through 90 days after the anchor procedure.
3. CMS will compare the aggregate Medicare fee-for-service expenditures for all items and services in the episode to the target price for the clinical episode semi-annually to assess each participant’s eligibility to receive CMS payment; if the participant’s spend is over the reconciled amount, they will be assessed a repayment to CMS.
4. The other two outpatient episodes of care are percutaneous coronary intervention and cardiac defibrillator procedures. CMS also released inpatient clinical episodes for back and neck procedures, cervical spinal fusion, combined anterior posterior spinal fusion and non-cervical spinal fusions.
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