Expert Insight into Bundled Payments

MedBen Analytics’ Data Usefulness Goes Beyond Reports

MedBen Analytics turns Medicare claims data into actionable reports, enabling you to find opportunities that impact your business. However, the usefulness of our bundled software platform doesn’t stop there.

When MedBen Analytics receives your data, our proprietary software first organizes it before producing the reports that help you interpret the data. But in addition to our reporting features, the arranged data is available as downloadable spreadsheets that can be used to merge with other medical data you have gathered for further analysis.

For instance, some hospitals participating in value-based care programs are working to reduce their use of disabling medications, in order to decrease patient side affects, lower length of stays, and reduce costs. Moreover, the ongoing opioid epidemic has led to a concerted effort to lessen the use of addictive medications and supplement them with safer alternatives. But such actions must be measured against satisfactory patient outcomes… and data processed through MedBen Analytics can be used in tandem with data from the medical records for this purpose.

Via the portal, a provider can generate a coordinated spreadsheet with length of stay and cost data, and then merge it with their own medical record data. This information can be reviewed together to analyze the safety and cost-effectiveness of reduced disabling medicine use.

Of course, this is just one example of how the usefulness of the MedBen Analytics platform can extend beyond report generation and interpretation. Learn more about how you the ways you can benefit from bundled payment data insights by contacting MedBen President and CEO Kurt Harden at 888-633-2364 or

CMS Releases Corrected PY1, PY2 Reconciliation Reports

Last week, The Centers for Medicare & Medicaid Services (CMS) released corrected Performance Year (PY) 1 final reconciliation reports and PY2 initial reconciliation reports. This action was taken after an error was detected in the application of exclusion logic for Bundled Payments for Care Improvement (BPCI) episodes during the 2018 Comprehensive Care for Joint Replacement (CJR) reconciliation processing.

While CMS believes that this error has not materially impacted every hospital’s PY1 final and PY2 initial reconciliation reports, the PY1 final reconciliation reports issued on both June 5, 2018 and June 29, 2018 and the PY2 initial reconciliation reports issued on both June 5, 2018 and June 29, 2018 have been withdrawn. Accordingly, all appeals received regarding these reconciliation reports have been dismissed.

The corrected reconciliation reports and related data files were posted to the CJR electronic funds transfer (EFT) accounts last week. Hospitals have 45 calendar days from date posted in the EFT account to appeal the new reconciliation reports. MedBen has retrieved the new files for our clients and will upload them in the MedBen Analytics Portal on Friday, August 3.

In light of these corrected reconciliation reports, clients who utilize MedBen Analytics’ CJR gainshare distribution services will receive a revised list of claim billing errors that could impact a physician’s eligibility to gainshare, or reduce the dollar amount they are able to receive. If you do not have these services, MedBen can administer the allocation of profits resulting from high-quality, cost-effective care between the hospital and its collaborators for a nominal fee.

Clients with questions regarding the PY1 and PY2 report changes are welcome to contact Cari L. Coventry, Manager of Operations for MedBen Analytics, at If you’re interested in setting up gainshare calculation and distribution services or to learn more about them, please contact MedBen President & CEO Kurt Harden at 888-633-2364 or email

CMS Announces Important Changes to BPCI Advanced

Two recent announcements by the Centers for Medicare & Medicaid Services (CMS) has altered the implementation and operation of the Bundled Payments for Care Improvement (BPCI) Advanced model:

  • CMS extended the deadline for returning the BPCI Advanced signed participation agreements and clinical episode selections to August 8, and the due date for program deliverables to Sept. 14 – both dates one week later than the original deadlines. The agency released a revised model timeline reflecting these changes.
  • CMS also announced that BPCI Advanced participants will be able to retroactively withdraw beginning in March 2019. The move serves as a compromise to the American Hospital Association and other industry groups, which had requested that the agency add additional start dates in 2019.

The changes were likely made due to delays in the transmission of target prices and data to applicants, originally scheduled for May but not delivered until June. CMS said it is still planning to announce participants this September, and has maintained that program will still launch on October 1 as previously scheduled.

Even with the additional seven days to return signed participation agreements and clinical episode selections, the window to formally participate in BPCI Advanced is quickly closing. But if you still have questions about the model or bundled payment programs in general, MedBen has the answers.

The MedBen Analytics reporting platform has been delivering bundled payment insights to health systems participating in CMS Bundled Payment Care Initiatives since 2015. Among our clients are Top 30 and Top 100 earners from the Comprehensive Care for Joint Replacement Program. We have managed bundled payment analytics for both retrospective and prospective BPCI participants.

MedBen Analytics is ready to help your organization make a smooth transition to bundled payments. For additional information or to set up a demonstration of our reporting platform, please contact MedBen President & CEO Kurt Harden at 888-633-2364 or email

MedBen Analytics Helps Client Detect Costly Care

A MedBen Analytics client discovered that when it comes to data analysis, it pays to compare… literally.

The client, a hospital system frustrated with its results from another data service, switched to MedBen Analytics. This client found immediate results, expanding the number of people with access to their data just by using our proprietary software. And the ability to drill down into reports and find opportunities to improve service has a demonstrable impact on the client’s bottom line.

A review of post-acute cost and stay lengths brought out a disturbing trend in skilled nursing use – it appeared that patients were consistently assigned to lengthy and costly skilled nursing stays. Using the average cost and stay data, the system and its physicians revised their discharge process to ensure patient received the most appropriate post-acute care.
The result? Happier patients, shorter stays, and hundreds of thousands of dollars in savings for the health system.

MedBen Analytics is more that just a reporting portal… our platform is designed to help your business evolve with the changes in health care payments by feeding relevant and timely payment data to your decision makers. We make it easier to uncover inefficiencies and make improvements throughout the patient journey.

MedBen Analytics invites you to compare for yourself. To set up a demonstration of our reporting platform, please contact MedBen President & CEO Kurt Harden at 888-633-2364 or email

BPCI vs. CJR: Participation and Performance

Using Medicare and American Hospital Association data, Health Affairs recently compared characteristics and baseline performance among hospitals in Medicare’s voluntary (Bundled Payments for Care Improvement initiative, or BPCI) and mandatory (Comprehensive Care for Joint Replacement Model, or CJR) joint replacement bundled payment programs.

Findings from their analysis include (per Becker’s Hospital Review):

  • BPCI hospitals generally were larger than CJR hospitals, and had higher average Medicare patient volume (nearly 7,200 compared to about 5,300).
  • BPCI hospitals were more likely to be nonprofit, teaching hospitals and sole community providers compared to CJR hospitals.
  • Both BPCI and CJR hospitals were similar as far as baseline readmission rates and mortality rates.
  • BPCI hospitals had greater cost from institutional post-acute care, primarily due to inpatient rehabilitation facility cost, but researchers note the differences are not large.

The study’s authors concluded: “These findings suggest that while both voluntary and mandatory approaches can play a role in engaging hospitals in bundled payment, mandatory programs can produce more robust, generalizable evidence. Either mandatory or additional targeted voluntary programs may be required to engage more hospitals in bundled payment programs.”

MedBen Analytics is used by BPCI and CJR participants alike, and based on CMS results and client feedback, both groups have realized success with our reporting portal. Our goal is to make sure that all providers, regardless of why they participate, can benefit from the bundled payment model.

We developed MedBen Analytics to give providers the insights they need to improve performance – and we earn and keep clients by proving that bundled payments save them time and money over traditional fee-for-service. If you ever have questions about how our services can benefit your business, please call MedBen President & CEO Kurt Harden at 888-633-2364 or email

With MedBen Analytics Reporting, Simplified Data Leads to Valuable Decisions

Whether you are a CEO, CFO, Surgeon or a Clinical Chief of Staff, MedBen Analytics has reports that will give you the insights you need to communicate effectively with your team and make impactful decisions.

Through the MedBen Analytics online portal, clients can access over two dozen distinct reports that enable them to interpret data from multiple perspectives, such as by facility, physician, or net payment reconciliation amount. For example, our Readmissions by MS-DRG report can be used by a decision support team to discuss clinical policy and quality metrics, which leads to improved patient outcomes. Or a CEO can see the broad performance view for one facility or multiple facilities within a system by reviewing our Cost Type Averages Summary.

Reports take seconds to run and the ability to drill down to specific, real-time information helps you find opportunities that affect your business. And all reports are easily exportable into a PowerPoint deck, Word or PDF document, or Excel spreadsheet with one click, allowing you to get the key information you need to communicate to stakeholders quickly and easily.

We invite you to read more about data presentation and some of our most popular reports at the MedBen Analytics website. Or if you’d prefer to see a demo of our reporting platform, please contact MedBen President & CEO Kurt Harden at 888-633-2364 or email

BPCI Advanced Features New Incentives, Care Episodes

As we noted in last week’s special insight edition, the Centers for Medicare & Medicaid Services (CMS) will roll out Bundled Payment for Care Improvement (BCPI) Advanced, a new voluntary bundled payment model, on October 1, 2018. Using the current BPCI initiative and other Center for Medicare and Medicaid Innovation (CMMI) models as its foundation, CMS has taken lessons learned from the earlier programs, in addition to provider input, and used them in the development of the Advanced model.

 “BPCI Advanced builds on the earlier success of bundled payment models and is an important step in the move away from fee-for-service and towards paying for value,” CMS Administrator Seema Verma said in a statement. “Under this model, providers will have an incentive to deliver efficient, high-quality care.”

While some of the elements of BPCI Advanced will be familiar to current BPCI participants, CMS has introduced new features to appeal to a greater provider population, as well as offering increased incentives.  Among them:

Advanced APM. To further incentivize providers, BPCI Advanced will qualify as an Advanced Alternative Payment Model (APM) under the Medicare Access and CHIP Reauthorization Act’s (MACRA’s) Quality Payment Program. Because participants take on additional financial risk, they can earn a five percent bonus.

Outpatient Care Episodes. Unlike the earlier BPCI initiative, the Advanced model offers participants three outpatient care episodes –  Percutaneous Coronary Intervention, Cardiac Defibrillator, and Back & Neck except Spinal Fusion. Meanwhile, inpatient episodes have been reduced to 29 (from the original 48), likely to better focus on those episodes that have demonstrated the greatest provider interest and potential for return.

Applications to participate in BPCI Advanced must be submitted by March 12, 2018 via the CMS Application Portal. If you’re interested in learning more about the new model, the CMS Innovation Center will conduct an hour-long Q&A session on January 30.

MedBen Analytics will be ready to support BPCI Advanced participants with actionable insights beginning with its schedule start this October. In the meantime, if you have any questions or are interested in viewing a demo of our current reporting platform, please contact Harden at 888-633-2364 or email

CMS Announces New Voluntary Bundled Payment Model; MedBen Analytics Will Provide Data Insights to Participants

On January 9, the Centers for Medicare & Medicaid Services (CMS) formally announced the introduction of Bundled Payments for Care Improvement Advanced (BPCI Advanced), a new voluntary episode payment model. MedBen Analytics, which has provided insightful reporting services for voluntary and mandatory bundled payment models since 2015, will support the new initiative for health systems and providers electing to participate.

BPCI Advanced builds on the foundation of the original BPCI initiative, which began in 2013 and is scheduled to run through September 30, 2018. The new model “aims to support healthcare providers who invest in practice innovation and care redesign, better coordinate care, improve quality of care, and consider the financial implications of their treatment decisions,” CMS said in a press release.

BPCI Advanced will start on October 1, 2018 and run through December 31, 2023. According to CMS, its model design elements include:

  • A voluntary episode payment model that qualifies as an Advanced Alternative Payment Model (Advanced APM);
  • A single payment and risk track with a 90-day post-discharge or post-procedure episode period;
  • 29 inpatient clinical episodes;
  • 3 outpatient clinical episodes;
  • Payment tied to performance on quality measures; and
  • Preliminary Target Prices provided prospectively.

MedBen Analytics will draw on its knowledge of Medicare data consolidation and analysis — backed by 80 years of experience in medical claims management — in the development of software for the BPCI Advanced model, said MedBen President and COO Kurt Harden.

“MedBen Analytics helped our clients thrive under the initial BPCI model,” Harden said. “We anticipate the Advanced model will be a major step forward in value-based care, and look forward to giving participants the insights necessary to achieve success.”

Request for Applications to participate in BPCI Advanced are available at the BPCI Advanced website. CMS says that additional introductory materials will soon be available on the site as well.

MedBen Analytics will provide further information and share observations on the new model as we receive it. In the meantime, if you have any questions or are interested in viewing a demo of our current reporting platform, please contact Harden at 888-633-2364 or email

A Note from our President: 2018 Offers Optimism, Opportunity 

Happy New Year from the MedBen Analytics team, as well as everyone else at MedBen! I hope that 2018 brings you good health and prosperity.

While MedBen Analytics is a fairly recent addition to our service line, MedBen itself has been around for quite a while… in fact, we’ll be celebrating our 80th anniversary this May. And I believe this blend works to the advantage of our clients – we have the energy that comes with a new offering and decades of experience in medical claims management to guide it.

The past year in value-based care has been, to say the least, interesting. The expectation was that in 2017, we would see the introduction of bundled payment initiatives for cardiac procedures and hip and femur fractures. But following multiple postponements, the Department of Health and Human Services cancelled those programs and scaled back the existing Comprehensive Care for Joint Replacement (CJR) model.

Despite these changes, we enter 2018 excited for the future of value-based care… and for the continued success of MedBen Analytics clients, many of whom received reconciliation payments in 2017.

Although mandatory programs have been reduced, the Centers for Medicare & Medicaid Services (CMS) looks to be expanding the voluntary Bundled Payments for Care Improvement (BPCI) Initiative. While the first phase of this program will end in September, CMS is apparently pleased with the savings to Medicare that BPCI has produced and is expected to announce phase two soon… and I expect that many hospitals and health systems that have been watching from the sidelines so far will be eager to participate in the program.

Ultimately, the success of bundled payment and other alternative payment models rests on the acceptance of those providers who see its potential benefits and willingly invest in value-based care. Our goal is to maximize that value to the advantage of you and your patients with reporting that is both detailed and straightforward, but most importantly offers actionable insights to help you save money while maintaining quality care.

One more thing: We always value your input. If you ever have a comment, question, or suggestion, do not hesitate to call me at 888-633-2364. I look forward to speaking with you in 2018.


Kurt Harden
President & COO, MedBen

Outpatient Arthroplasty Provision Requires Team Strategy

The Medicare hospital outpatient prospective payment system (OPPS) final rule includes something that will have a direct bearing on the Bundled Payment for Care Improvement (BPCI) and Comprehensive Care for Joint Replacement (CJR) models: a provision that removes total knee arthroplasty from the inpatient-only list beginning in January 2018.

The broadening of how Medicare will reimburse the procedure raises the question of how it will affect bundled payments – specifically, whether or not a potential shift of younger, healthier patients choosing the outpatient option will skew BPCI and CJR outcomes.

In the final rule, the Centers for Medicare & Medicaid Services (CMS) stresses that while it does not expect a “significant volume” of total knee arthroplasty cases to switch to outpatient treatment, it will monitor the situation and make adjustments if necessary. But the bottom line is, no one knows for certain the effect the provision will have on model pricing.

What we do know for sure is that the change will affect the decision-making that goes into which patients are better suited for outpatient treatment and which will best benefit from a longer hospital stay. Toward that goal, the smart strategy right now is for your administrative and clinical teams to evaluate the possible impact to reimbursement, pre-certification, and patient care and prepare accordingly, making process changes where necessary.

When CMS finalizes the model changes, MedBen Analytics will offer further insights. In the meantime, if you wish to share your own thoughts about the OPPS outpatient arthroplasty provision, you can contact CMS no later than 5 p.m. EST on December 31, 2017. Electronic comments are preferred, but you can also submit your comments by regular mail, express/overnight mail, or hand/courier. The OPPS rule provides detailed submission instructions beginning on page 2.