---
title: Medicare BPCI Reconciliation Form Template for Healthcare Practices | Paperform
description: Professional BPCI reconciliation form for medical practices to compare actual episode costs against Medicare target prices, calculate variance, and document bundled payment performance for CMS reporting.
url: "https://paperform.co/templates/medicare-bpci-reconciliation-form"
type: static
generatedAt: "2026-03-28T00:44:30.198Z"
---

[← Back to free form templates](/templates/)    ![Medicare BPCI Reconciliation Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/medicare-bpci-reconciliation-form.png)
    [Preview](https://_preview.paperform.co/ai-template/medicare-bpci-reconciliation-form) [Use this template for free](/create?ai-template=medicare-bpci-reconciliation-form)    [Healthcare & Medical Forms](/templates/category/healthcare/)[Financial & Accounting Forms](/templates/category/financial/) [Healthcare](/templates/industry/healthcare/) [Manager](/templates/role/manager/)[Healthcare Administrator](/templates/role/healthcare-admin/)[Accountant](/templates/role/accountant/)     About this free form template
Healthcare practices participating in Medicare's Bundled Payment for Care Improvement (BPCI) initiative need a streamlined way to reconcile actual episode costs against target prices and submit comprehensive financial documentation. This Medicare BPCI reconciliation form template provides a structured approach for medical billing departments and practice administrators to track episode performance, calculate cost variances, and maintain compliance with CMS reporting requirements.

### Built for Value-Based Care Administration

This template is designed specifically for medical practices, hospitals, and post-acute care providers participating in BPCI Advanced or similar bundled payment models. Use it to document episode details, compare actual costs to target prices, calculate shared savings or losses, and prepare reconciliation reports for CMS submission. The form captures essential data including episode identification, clinical metrics, cost breakdowns by service category, and variance analysis.

### Streamline Your BPCI Reporting with Paperform

Paperform makes it simple to digitise complex healthcare billing workflows. Instead of managing spreadsheets and paper forms, create a branded, professional reconciliation form that calculates variances automatically and routes submissions to the right team members. Connect your completed reconciliations to your practice management system, trigger follow-up workflows in [Stepper](https://stepper.io) for approval chains and CMS reporting, or export data directly to your accounting software.

With conditional logic, you can show different fields based on episode type or outcome, ensuring your billing team only sees relevant questions. Calculation fields handle complex formulas for variance analysis, percentage calculations, and savings determinations—eliminating manual errors and speeding up the reconciliation process.

### Trusted by Healthcare Providers Nationwide

This template is ideal for hospital billing departments, ACO administrators, physician practice managers, and healthcare finance teams managing bundled payment arrangements. While Paperform is SOC 2 Type II compliant and built with security in mind, please note that Paperform is not a HIPAA-compliant solution. This form is designed for financial and administrative data reconciliation rather than protected health information (PHI).

Whether you're reconciling a single episode or managing dozens of bundles each quarter, Paperform gives you the flexibility to customize fields, automate calculations, and integrate with the tools you already use—helping your practice maximize shared savings opportunities and stay compliant with CMS requirements.
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