Bundled Payment Programs

Model 4 CABG Bundled Payment Program

Program Overview

JSUMC is participating in a special CMS (Medicare) Bundled Payments for Care Improvement (BPCI) initiative with its coronary artery bypass graft (CABG) patients. In Model 4, CMS determines a standard payment for each MS DRG that must cover all Part A and Part B service claims (hospital, physicians, and readmissions) for care up to 30 days post discharge. This “bundled payment” is paid to the hospital which then reimburses the other healthcare providers who were involved in the patients’ care. Physicians and post-acute care providers do not bear any financial risk. They will be reimbursed for the full amount of their submitted claims. The program officially begins on January 1, 2014. More information is available in the Reference Documents section.

Care Provider Information

If you provide care to CABG patients, here’s what you need to know:

  •  A “Part B Participation Agreement” must be completed and submitted before a Part B claim can be paid. Payments cannot be retroactively made by JSUMC. The claim would need to be resubmitted to CMS with the appropriate modifier on each line of service. A copy of the Agreement can be requested by calling the Medical Management Department at 732-776-4734 or emailing Leigh Romano at lromano@meridianhealth.com.
  • JSUMC has contracted with EA Health to assist in the claims reimbursement process. Information about this process and the expected payment time line can be found in the Reference Documents section.
  • Physicians have an opt-out option for each line of service on a claim. To learn more about the opt-out modifier and process visit the Reference Documents section.

Reference Documents

CMS requires all participants in the Model 4 program have access to specific documents about the initiative and its implementation at JSUMC. Copies of these documents and other reference materials can be found here: