Medicare Shared Savings Program

News & Analysis as of

8 tips for engaging ACO boards to meet requirements in the Final Waivers

In the Final Waivers for the Medicare Shared Savings Program (MSSP) issued by the CMS and the OIG, the regulators modified the requirements for the ACO governing body stating that it must provide “the basis for the...more

Medicare Rolls Out Proposed Rule Altering Physician Payment Model

Currently, Medicare measures the value and quality of care provided by doctors and other clinicians through a patchwork of programs. Some clinicians are part of Alternative Payment Models such as the Accountable Care...more

IRS Ruling Sounds Alarm over Tax-Exempt Status of Nonprofit ACOs Operating outside of the Medicare Shared Savings Program

On April 8, 2016, the IRS released private letter ruling 201615022 denying tax-exempt section 501(c)(3) status to a nonprofit accountable care organization (“ACO”) that did not participate in the Medicare Shared Savings...more

IRS Denial of Section 501(c)(3) Status for a Commercial ACO

The IRS recently released a ruling, Private Letter Ruling (“PLR”) 201615022, denying Section 501(c)(3) tax-exempt status to a “commercial” accountable care organization (“ACO”). This is the IRS’ first published guidance...more

CMS Ahead of Schedule in Push for Medicare Alternative Payment Models

CMS has announced that has reached its goal of tying 30% of Medicare payments to alternative payment models that reward quality of care rather than volume of service — 11 months ahead of the target CMS set last year....more

CMS Issues a New Medicare Shared Savings Program Proposed Rule and Aims to Encourage Existing Accountable Care Organizations to...

On February 3, 2016, the Centers for Medicare and Medicaid Services (“CMS”) issued a new proposed rule that makes a number of revisions to the Medicare Shared Savings Program (“MSSP”). Several of the proposed changes create...more

CMS Schedules Calls on Medicare ACO Application Process (April 5 and 19)

CMS is holding two calls in April on the Medicare Shared Savings Program/Accountable Care Organization application process. The first call, scheduled for April 5, will focus on preparing for the Shared Savings Program...more

CMS Listening Session on Proposed Changes to Medicare Shared Savings Program Rules (March 3)

On March 3, CMS is hosting a “listening session” to receive feedback on proposed changes to the Medicare Shared Savings Program benchmarking methodology published on February 3, 2016. In particular, CMS invites comments on...more

Health Update - February 2016

Better Late Than Never: CMS Provides Much-Needed Clarity on the 60-Day Overpayment Refund Requirements - On February 12, 2016, the Centers for Medicare & Medicaid Services (CMS) issued the long-awaited final rule (Final...more

Proposed Changes to Methodology to Update ACO Benchmarks

The Medicare Shared Savings Program provides financial rewards to Accountable Care Organizations (ACO’s) that successfully manage overall health care costs for a defined population of beneficiaries while meeting quality of...more

CMS Proposes Additional Changes to MSSP Regulations

The Centers for Medicare and Medicaid Services (CMS) recently issued a proposed rule modifying the Medicare Shared Savings Program (MSSP) regulations (the “Rule”). Among other changes, the Rule proposes (a) to modify the...more

CMS Proposes Changes to Medicare Shared Savings Program/ACO Benchmark Rebasing Rules

On February 3, 2016, CMS published a proposed rule that would revise the methodology CMS uses to measure the performance of accountable care organizations (ACOs) in the Medicare Shared Savings Program (Shared Savings Program)...more

Important Changes for Physicians from the 2016 Medicare Physician Fee Schedule: Part II (Non-Stark Changes)

On November 16, 2015 the Centers for Medicare and Medicaid Services (CMS) published the final Medicare Physician Fee Schedule (Final MPFS).1 The Final MPFS addresses changes to the physician fee schedule and related policies,...more

CMS Announces Next Generation ACO Program

On January 11, 2016, the Centers for Medicare & Medicaid Services (CMS) announced the Next Generation ACO program, along with the first group of participants. The program builds on the CMS Pioneer ACO Model and Medicare...more

Senate Passes Rural ACO Legislation

On December 17, 2015, the Senate approved S. 2261, the Rural ACO Provider Equity Act of 2015. This legislation would modify how beneficiaries are assigned under the Medicare shared savings program by considering services...more

2016 Will Be the Year of Telemedicine and ACOs

If 2015 was the year that brought telemedicine directly to consumers, 2016 will be the year of telemedicine and Accountable Care Organizations (ACOs). ACOs are expected to increase the use of telemedicine technologies as a...more

CMS Call: 2016 Medicare Physician Quality Reporting Programs (Dec. 8)

On December 8, 2015, CMS is hosting a call to discuss how the 2016 Medicare Physician Fee Schedule final rule impacts Medicare quality reporting programs. Specifically, the call will address changes to the Physician Quality...more

CMS and OIG Issue Final Rule on Fraud and Abuse Waivers for ACOs

On October 29, 2015, the Centers for Medicare & Medicaid Services (CMS) and the Office of the Inspector General (OIG) of the Department of Health and Human Services published a final rule related to fraud and abuse law...more

CMS and OIG Issue Final Fraud and Abuse Waivers in Connection With the Medicare Shared Savings Program

Nearly four years after introducing waivers to certain fraud and abuse laws for Accountable Care Organizations (“ACOs”) and other entities participating in the Medicare Shared Savings Program (“MSSP”), the Centers for...more

CMS and OIG Finalize Waivers of Fraud and Abuse Laws Applicable to Medicare ACOs

On October 29, 2015, the Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General (OIG) published a final rule regarding the waiver of several federal health care fraud and abuse laws with respect...more

CMS Issues Final Rule for Fraud and Abuse Waivers in the Medicare Shared Savings Program

On October 29th, 2015, the Centers for Medicare and Medicaid Services (“CMS”) issued its final rule (“Final Rule”) for waivers of fraud and abuse laws in the context of the Medicare Shared Savings Program (“Shared Savings...more

Limited Modifications in Final ACO Fraud and Abuse Waivers Most Notably Include Cut of Gainsharing CMP Waiver

Nearly four years after publishing their joint interim final rule with comment period, effective November 2, 2011 (IFC), the OIG and CMS (Agencies) have finalized the waivers of various fraud and abuse laws in the context of...more

CMS and OIG Issue Final ACO Waivers

On Thursday, October 29, 2015, the Centers for Medicare & Medicaid Services (“CMS”) and the Office of Inspector General (“OIG”) jointly issued a rule (the “Final Rule”) to finalize five (5) waivers of certain fraud and abuse...more

Top Three Reasons ACOs Should Use Telehealth and Telemedicine

Accountable Care Organizations (ACOs) can share costs of telehealth and remote patient monitoring services among their hospitals, providers/suppliers, and other ACO participants, according to federal regulations under the...more

CMS/OIG Finalize Fraud Authority Waivers for Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program...

The Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) have finalized a rule designed to “remove legal and regulatory barriers that can impede care coordination in furtherance of the...more

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