The Cardiac Rehabilitation (CR) Incentive Payment Model: What it is and What it Means For Your Practice

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The Cardiac Rehabilitation Incentive Payment Model is a proposal outlined by the Centers for Medicare and Medicaid Services (CMS) to promote and increase the use of cardiac rehabilitation services for acute myocardial infarction (AMI) and coronary artery bypass graft (CABG) patients.

Through this model, CMS hopes to actualize the underutilized potential that cardiac rehabilitation has in improving patient outcomes. The concept behind the proposal is that patients who start a cardiac rehabilitation program are more likely to continue with follow-up sessions and therefore, are predicted to have a reduced risk of heart attack or death.

For providers, this means improved patient outcomes, increased quality of care, as well as increased payments. The performance period is set to begin July 1, 2017 and will run for five years through December 31, 2021.

What Qualifies as a Cardiac Rehabilitation Service?

Cardiac rehabilitation services will be determined based on their Healthcare Common Procedure Coding System (HCPCS) codes; more specifically, codes 93797, 93798, G0422, and G0423.

Who Will Participate in the New CR Incentive Payment Model?

Participants will include 90 inpatient prospective payment system (IPPS) hospitals. Forty-five of these hospitals will be chosen from metropolitan statistical areas (MSAs) elected to participate in the AMI/CABG episode payment model (EPM) program, while the remaining 45 will be chosen from MSAs that were eligible for the AMI/CABG EPM, but weren’t elected to participate.

How Will Incentive Payments be Awarded?

Providers will be given regular reimbursement payments from Medicare for cardiac rehabilitation services. Additional incentive payments will be awarded retrospectively for each performance year when medically necessary CR services are rendered to patients hospitalized for AMI or CABG reasons during a 90-day post-discharge period.

The incentive payment structure is outlined as follows:

  • $25 for each of the first 11 cardiac rehabilitation services rendered during an AMI or CABG episode/care period that was paid for by Medicare
  • $175 for each additional cardiac rehabilitation service rendered, after the 11th session,  during an AMI or CABG episode/care period that was paid for by Medicare

What Does This Mean for Your Practice?

For participating hospitals, the Cardiac Rehabilitation Incentive Payment Model offers an incentive-based pathway to improved quality of care and improved patient outcomes for AMI and CABG patients as well as increased revenue as a result of additional reimbursements from Medicare for your practice.

1st Providers Choice is dedicated to helping hospitals deliver high-quality care efficiently. Our cardiology EMR is designed to help streamline tasks while facilitating improved care coordination.

To learn more about how we can help your hospital with practice management for the Cardiac Rehabilitation Incentive Payment Model, contact us online or call us at 480-782-1116.