Application Only Allows for Episodes Beginning and Ending in CY 2009

[Michael]

In reviewing the output from the freeware, we noticed that the reports
are including claims that were admitted in CY 2008 but are discharged
in CY 2009 since they are in the 2009 data files. We believe this
contradicts what CMMI has stated (in their data webinars and technical
assistance calls) and published as they have maintained that they only
wanted applicants to focus on bundles that started and ended in CY
2009.

From the BPCI Application, under Section C, Question 1:

"Under 'Historical Episode Payment', please list the total 2009
historical payment for each service type for that organization for all
episode cases that began and ended in calendar year 2009 including all
MS-DRGs that were included in the episode parameters in Section B."

From the CMMI's BPCI Application Guidance Document:

"Regarding the time period of the analysis, please use only episodes
that both start and end in calendar year 2009 to complete your
analysis. In Models 2 and 4, the episode begins at hospital
admission. As such, if the admission date is in 2008, the episode
does not start and end in calendar year 2009 even if the claim through
date is in 2009 and thus the claim appears in the 2009 file. In Model
3, if an anchor admission begins in 2008, the episode can be included
as long as post-acute services are initiated (and thus the episode is
initiated) in calendar year 2009."

Are there any plans to correct how the freeware is handling this
issue? If not, what would be the best approach to correct it on our
end?

[Elizabeth Bailey]

Hi Michael,

Thanks for your note. The freeware was built/released prior to this
guidance from CMS. You can exclude those episodes that overlap
manually by reviewing report 7. The logic built in the program assigns
year by date of discharge. Thanks.

Sent from my iPhone