In the spring of 2015, we started to notice a few inconsistencies when we compared the episodes that we internally tracked to the CMS claims for our physician group practice (PGP) clients that were live in BPCI. We found some groups with physicians assigned to them who didn’t work at the practice, causing episodes to be inappropriately assigned to the group. We also found groups that were missing physicians who were initiating episodes, causing the group to not get credit for certain episodes. We immediately brought this issue to the attention of CMS and they confirmed that we weren’t the only awardee experiencing these types of issues. On March 9th, CMS sent an email outlining their plans to resolve the issue. They provided a PGP Reassignment Correction workbook and asked that it be completed by April 11th. One of the more popular comments they received from impacted awardees was that completing the corrections workbook was time-consuming. In response, CMS moved the due date to April 22nd.
The good news for directly impacted awardees is that positive NPRA will be distributed on time and that negative NPRA collections will be delayed until the October 2016 reconciliation period. The bad news is that the preliminary reconciliations that CMS is performing prior to October 2016 are likely to be wrong.
To estimate what our clients should expect during the October 2016 reconciliation period, we’re running our own reconciliations based on the PGP reports as accurate as we can make them. We’re using the quarterly PGP Reassignment lists and comparing them to our internal episode tracking data to highlight which physicians are missing or listed in error. If you’d like to learn more about how we can help you estimate your October 2016 NPRA, please let us know.