The removal of Total Knee Arthroplasty (TKA) procedures from the CMS inpatient-only list in January 2018 resulted in no small number of provider questions regarding how Medicare would pay for TKA claims under the revised rules. Initial CMS attempts to clarify billing issues served, in some cases, to only muddy things further.

This January, as part of the Medicare Learning Network (MLN), CMS issued “TKA Removal from the Medicare Inpatient-Only (IPO) List and Application of the 2-Midnight Rule.” This document was created with the purpose of explaining what this change means for Medicare providers.

As the document states, the IPO removal “allows Medicare payment to be made to the hospital for TKA procedures regardless of whether a beneficiary is admitted to the hospital as an inpatient or as an outpatient, assuming all other criteria are met.” Additionally, MLN offers examples of TKA cases and the rationale for payment determinations.

MedBen can’t state for certain that this document will clear up every question you may have about TKA claims, but since it appears to be a valid effort to address outstanding questions, we wanted to bring it to your attention.

Now, should you have any TKA questions regarding data reporting, that’s where MedBen Analytics can help. Our work with participants in the Bundled Payments for Care Improvement (BPCI) and Comprehensive Care for Joint Replacement (CJR) models have given us valuable knowledge about how providers can use bundled payment data to make improvements to patient care while unlocking profit potential.

MedBen Analytics has the solutions to help your organization evolve with the changes in health care payments. Find out more about how you can benefit from our data insights by contacting MedBen President and CEO Kurt Harden at 888-633-2364 or email