BPCI Tutorial Video 7: NPRA, of Budgets and Actuals
Within the BPCI program, we allocate the amount of money that’s acceptable to spend on a particular episode of care. This amount is called your Target Price. It includes the mandatory CMS discount of2-3% (based on your model). Through the retrospective reconciliation process integral to models 2 and 3, we compare this Target Price to the actual amount of money spent on each patient episode.
The difference between planned spend (Target Price) and actual spend (claims) is called NPRA orNet Payment Reconciliation Amount. This difference is aggregated across all patient episodes, and all clinical episodes to the episode initiator level.
Instances where the Episode Initiator spent more money relative to the Target Price are loss leaders, or negative NPRA episodes. Episode initiator owes CMS the amount spent over the Target Price.
When the actual spend is below Target Price and NPRA is positive, it’s an occasion to celebrate. CMS gets to save money through the mandatory discount (2-3%) in the target price and the Episode Initiator brings home the bacon in NPRA savings!