tci Medicare Compliance & Reimbursement - 2015 Issue 14
Reimbursement: ACOs: Understand The 5 Big Changes In The MSSP Final Rule
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Article Overview
This article explains recent CMS changes to the Medicare Shared Savings Program for accountable care organizations. It is relevant to providers, ACO administrators, and reimbursement professionals who need a broad understanding of how the final rule affects participation options, risk arrangements, beneficiary assignment, data sharing, and benchmarking. The article focuses on policy and operational guidance rather than coding mechanics.
Why This Topic Matters
CMS policy changes in the MSSP can affect ACO participation decisions, financial risk, reporting workflows, and care management operations. Understanding the scope of these updates helps organizations evaluate program impact and prepare for implementation.
Article Sections
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Get Another Round of Track 1 Time
Overview of an additional agreement period option under the MSSP and the general participation conditions discussed for existing ACOs.
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Take a Look at the New Track 3
Discussion of a new risk-based MSSP track, related participation features, and other track-level program changes described in the article.
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Take the Pain Out of Beneficiary Assignment
Summary of revisions to beneficiary assignment methodology and related timing, specialty, and primary care service updates.
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Enjoy Streamlined Data Sharing
Explanation of changes to the process for beneficiary claims data access and the general notification workflow described by CMS.
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How Your Financial Benchmarks Will Change
Overview of benchmark rebasing and related methodology changes for subsequent agreement periods under the program.
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Are Final Rule’s Changes Enough?
Closing discussion of stakeholder reactions and broader commentary on whether the policy changes are sufficient for program participation and adoption.
What You Will Learn
- How the MSSP final rule changes ACO participation options
- What the article says about revised risk-based track structures
- How beneficiary assignment and data sharing processes are changing
- What benchmark methodology updates are highlighted
- How stakeholders are responding to the CMS policy updates
Who Should Read This
- Accountable care organization leaders
- Hospitals and health systems
- Physician practices
- Medical reimbursement and compliance staff
- Healthcare policy readers
Codes Discussed
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