Issue link: https://beckershealthcare.uberflip.com/i/937560
30 CODING & BILLING CMS Cancels Hip Fracture, Cardiac Bundles and Finalizes CJR Model: 5 Things to Know By Laura Dyrda C MS canceled the mandatory hip fracture and cardiac bundled payments that would have gone into effect Jan. 1, and made changes to the Comprehensive Care for Joint Replacement Model with the goal of offering more flexibility. "While CMS continues to believe that bundled pay- ment models offer opportunities to improve quality and care coordination while lowering spending, we believe that focusing on developing different bundled payment models and engaging more pro- viders is the best way to drive health system change while minimizing burden and maintaining access to care," said CMS Administrator Seema Verma. "We anticipate announcing new voluntary payment bundles soon." Here are five things to know about the final rule: 1. CMS reduced the number of geographic areas participating in CJR on a mandatory basis from 67 to 34. 2. As of Feb. 1, CJR will not be mandatory for low- volume hospitals — those with fewer than 20 CJR episodes in total over the past three years — or rural hospitals in the covered geographies. However, rural hospitals can choose to participate if they comply with CJR regulations. 3. e final rule includes an interim final rule with a comment period to seek feedback on the final policy and provide additional flexibility in episode of care costs for providers in areas that were impacted by "extreme and uncontrollable circumstances," includ- ing last year's hurricanes. 4. In the future, CMS expects to roll out addi- tional opportunities for providers to participate in voluntary initiatives instead of mandatory bundled payment models. 5. e agency decided to cancel proposed bundles for hip fractures and cardiac care and will instead focus efforts on designing and testing models to improve care coordination across the inpatient and post-acute care spectrum. n CMS to Terminate Seattle ASC's Medicare Benefits After Failed Survey — 5 Insights By Eric Oliver CMS terminated its Medicare provider agreement with Seattle-based Active Foot and Ankle Center Nov. 17, 2017. Here's what you should know: 1. CMS found the surgery center was "not in compliance with require- ments for participation in the Medicare/Medicaid programs." 2. A team of Washington Department of Health surveyors surveyed the center on behalf of CMS, determining it was noncompliant in August 2017. The specific violation was not disclosed. 3. CMS no longer provides payment for services for Medicare and/or Medicaid beneficiaries admitted to the center. 4. Mark Kuzel, DPM, and Edward Chestnutis, DPM, are the center's primary physicians. 5. The center specializes in foot and ankle services. The ASC has its own onsite imaging services and offers patients nonsurgical treatment options. Note: A representative of Active Foot and Ankle Center was unavailable for comment before publication. n The 10 Largest Health Insurance Companies by Membership By Eric Oliver Insider Monkey compiled the 10 largest U.S. health insurance compa- nies by total enrollees. Here are the top 10 from most members to fewest members. 1. UnitedHealthcare Group, 70 million members 2. Anthem, 39.4 million members 3. Aetna, 23 million members 4. Health Care Services Corp., 15 million members 5. Cigna, 14.7 million members 6. Humana, 14.23 million members 7. Centene Corp., 11 million members 8. Kaiser Permanente, 10.7 million members 9. Highmark, 5.3 million members 10. WellCare Health Plans, 3.68 million members n