Bundled Payments for Care Improvement Advanced Model
(BPCI Advanced)

What are bundled payments?

A bundled payment combines, or bundles together, payments that Medicare makes to your health care providers for the many different kinds of medical services you might get in a specific time period. In BPCI Advanced, this time period could include a hospital inpatient stay or outpatient procedure, plus 90 days.

What does BPCI Advanced mean for me?

You’re more likely to get even better care when hospitals, doctors, and other health care providers work together. In BPCI Advanced, hospitals, doctors, and other health care providers may be rewarded for providing better, more coordinated health care. Medicare will watch BPCI Advanced participants closely to make sure that you and other patients keep getting efficient, high quality care.

What do I need to know about BPCI Advanced?

What’s most important for you to know is that your Medicare rights and benefits don’t change because your health care provider is participating in BPCI Advanced. Medicare will keep covering all of your medically necessary services.

Even though Medicare will pay your doctor in a different way under BPCI Advanced, how much you have to pay won’t change. Health care providers and suppliers who are enrolled in Medicare will submit their Medicare claims like they always have.

You’ll have all the same Medicare rights and protections, including the right to choose which hospital, doctor, or other health care provider you see. If you don’t want to get care from a health care provider who’s participating in BPCI Advanced, then you’ll have to choose a different health care provider who’s not participating in the Model.

Where can I learn more about BPCI Advanced?

Learn more about BPCI Advanced at https://innovation.cms.gov/initiatives/bpci-advanced/:

  • A list of all the hospitals and physician group practices in the country participating in BPCI Advanced.
  • All of the inpatient and outpatient Clinical Episodes that are currently included under BPCI Advanced. A Clinical Episode is a grouping of medical conditions or diagnoses that are included in the BPCI Advanced Model.

Still Have Questions? Contact:
Novella Thompson, Administrator, 434.297.7152nwt4k@virginia.edu
David Harlow, Administrative Program Coordinator, 434.243.4603dh9pu@virginia.edu
Cynthia Woodring, Administrative Program Coordinator, 434.297.5101cw5gq@virginia.edu