decisionhealth Newsletters, Part B News - 2016 Issue 11 (November)
Shared Savings ACOs get assigned beneficiaries, measure changes in fee schedule
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Article Overview
This article covers CMS policy changes affecting Medicare Shared Savings accountable care organizations under the Physician Fee Schedule and related Medicare Shared Savings Program rules. It explains broad updates to beneficiary assignment, a skilled nursing facility waiver policy, quality measure additions and retirements, and changes to audit procedures and reporting responsibilities. The material is relevant for ACO administrators, physician practices, compliance staff, and healthcare finance professionals following CMS quality and payment rulemaking.
Why This Topic Matters
These changes can affect how ACOs are organized, how performance is measured, how reporting is audited, and how participating organizations manage Medicare beneficiaries and post-acute care arrangements.
Article Sections
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Physician Fee Schedule
Overview of the CMS policy context for the article and the Medicare program changes being discussed.
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Waiver of 3-day hospital stay before SNF
Discussion of a Shared Savings Program policy change related to skilled nursing facility access and affiliate arrangements.
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2 more changes to Shared Savings
Summary of additional Shared Savings Program updates, including quality measure reporting and audit process changes.
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Measure changes.
Overview of modifications to the Shared Savings quality measure set, including additions and retirements tied to broader CMS reporting alignment.
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Audits.
Discussion of changes to quality reporting verification and how audit procedures will be handled under the updated process.
What You Will Learn
- How CMS is changing beneficiary alignment for Shared Savings ACOs
- What policy changes are being made to the SNF three-day stay waiver
- Which broad categories of quality measures are being added or retired
- How audit procedures for ACO quality reporting are being revised
- Which reporting responsibilities may apply under the updated CMS framework
Who Should Read This
- ACO administrators
- Physician practice managers
- Compliance and reporting staff
- Healthcare reimbursement professionals
- Medicare policy observers
Codes Discussed
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