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The R.A.I.N. (Referral Accountability for Integrated Networks) Compliant™ standards are strategically designed for the Centers for Medicare & Medicaid Services (CMS) TEAM Model to empower Health Systems and healthcare provider groups to deliver superior patient care and maximum reimbursements. This framework ensures a structured approach that prioritizes efficiency and outcomes in healthcare.
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The Transforming Episode Accountability Model (TEAM) is a new mandatory payment model proposed by CMS in the 2025 IPPS Proposed Rule. 741 Facilities are mandated to participate. CMS will hold hospitals accountable for specific episodes of care by making reimbursement amounts contingent on care given.
Under the TEAM model, selected hospitals would be responsible for coordinating the care of Medicare beneficiaries who undergo certain surgical procedures, from the time of surgery until 30 days after the patient leaves the hospital. Hospitals are responsible for all items and services provided during an episode of care. This would significantly disrupt how hospitals operate outpatient and specialty departments, as well as owned post-acute care assets and external networks.
We leverage our EHR-Integrated AI-enabled framework to build a data-driven approach to maximize your CMS reimbursements and deliver better outcomes.
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1. Assessment: Conduct a readiness assessment covering clinical, operational, and financial documentation and workflows.
2. Audit: Identify a ranking using our proprietary framework built by industry experts and executives for necessary investments in infrastructure.
3. Data Modeling: Utilizing proprietary frameworks and the most up-to-date policy requirements with a flexible and AI-enabled technology platform
4. Strategic Insights: Create a comprehensive implementation plan that addresses all TEAM model components.
5. Technology Enabled Implementation: Scalable insights for all relevant sights with personalized components to maximize reimbursement.
6. Continuous Monitoring: Use real-time information to maintain goals and gain insights for the entirety of the model with ongoing education.
The stakes for TEAM are significant. The model affects five high-volume surgical episodes that typically represent about 15% of a hospital's Medicare revenue.
This historic committee is made of select Healthcare Executives and Operators that will help create operational and technology frameworks for healthcare systems. The Advisory Committee provides strategic guidance to promote healthcare accessibility. By holding healthcare organizations accountable to measurable benchmarks, the Committee aims to use best operational practices for the betterment of all communities.Full Committee Directory Coming Soon.
If you're interested in learning more about the R.A.I.N. Compliant™ Standards and how they can help drive equitable, accessible, and accountable healthcare, please schedule a demo to learn more.
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