{"id":12258,"date":"2024-07-03T11:22:11","date_gmt":"2024-07-03T11:22:11","guid":{"rendered":"https:\/\/distilinfo.com\/healthplan\/?p=12258"},"modified":"2024-07-03T11:22:11","modified_gmt":"2024-07-03T11:22:11","slug":"cms-safeguards-acos-protection-rule","status":"publish","type":"post","link":"https:\/\/distilinfo.com\/healthplan\/cms-safeguards-acos-protection-rule\/","title":{"rendered":"CMS Safeguards ACOs with Crucial Protection Rule"},"content":{"rendered":"\r\n<div id=\"rank-math-toc\" class=\"wp-block-rank-math-toc-block has-electric-grass-gradient-background has-background\"><nav>\r\n<ul>\r\n<li><a href=\"#introduction\">Introduction<\/a><\/li>\r\n<li><a href=\"#cms-proposal-to-protect-ac-os\">CMS Proposal to Protect ACOs<\/a><\/li>\r\n<li><a href=\"#details-of-the-proposed-rule\">Details of the Proposed Rule<\/a><\/li>\r\n<li><a href=\"#industry-reactions-and-support\">Industry Reactions and Support<\/a><\/li>\r\n<li><a href=\"#future-implications-and-policies\">Future Implications and Policies<\/a><\/li>\r\n<li><a href=\"#conclusion\">Conclusion<\/a><\/li>\r\n<li><a href=\"#fa-qs\">FAQs<\/a>\r\n<ul>\r\n<li><a href=\"#1-what-is-the-cm-ss-proposed-rule-about\">1. What is the CMS&#8217;s proposed rule about?<\/a><\/li>\r\n<li><a href=\"#2-why-was-this-rule-proposed\">2. Why was this rule proposed?<\/a><\/li>\r\n<li><a href=\"#3-how-will-this-rule-impact-ac-os\">3. How will this rule impact ACOs?<\/a><\/li>\r\n<li><a href=\"#4-who-has-supported-the-cm-ss-proposal\">4. Who has supported the CMS&#8217;s proposal?<\/a><\/li>\r\n<li><a href=\"#5-what-are-the-future-implications-of-this-rule\">5. What are the future implications of this rule?<\/a><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<\/nav><\/div>\r\n\r\n\r\n\r\n<h3 id=\"introduction\" class=\"wp-block-heading\">Introduction<\/h3>\r\n\r\n\r\n\r\n<p>ACOs (Accountable Care Organizations) have been concerned about potential financial repercussions due to fraudulent activities within the Medicare system. The Centers for Medicare &amp; Medicaid Services (CMS) has proposed a rule that offers significant relief to these organizations. This rule aims to protect Accountable Care Organizations from financial penalties related to fraudulent intermittent urinary catheter claims, ensuring their sustainability and continued participation in the Medicare Shared Savings Program (MSSP).<\/p>\r\n\r\n\r\n\r\n<h3 id=\"cms-proposal-to-protect-ac-os\" class=\"wp-block-heading\">CMS Proposal to Protect ACOs<\/h3>\r\n\r\n\r\n\r\n<p>The CMS&#8217;s new proposal, introduced on Friday, aims to exclude certain payments for intermittent urinary catheters from the performance year 2023 financial assessments for MSSP ACOs. This exclusion is a proactive measure to ensure that ACOs are not unjustly penalized due to fraudulent billing practices by bad actors. The CMS intends to set new benchmarks for the years 2024, 2025, and 2026 to maintain the integrity of the MSSP.<\/p>\r\n\r\n\r\n\r\n<h3 id=\"details-of-the-proposed-rule\" class=\"wp-block-heading\">Details of the Proposed Rule<\/h3>\r\n\r\n\r\n\r\n<p>The proposed rule, detailed in a PDF document, states that payment amounts for specific intermittent urinary catheters will not be considered in the financial performance evaluations of ACOs for the year 2023. This decision came after unusual billing irregularities were discovered, indicating a dramatic increase in payments to beneficiaries for these items.<\/p>\r\n\r\n\r\n\r\n<p><a href=\"https:\/\/www.medicaleconomics.com\/view\/naacos-praises-cms-proposed-rule-on-accounting-for-alleged-catheter-billing-fraud\" target=\"_blank\" rel=\"noopener\">Clif Gaus, President and CEO of the National Association of ACOs<\/a> (NAACOS), praised CMS for this move. He highlighted that this rule would ensure that healthcare providers and Accountable Care Organizations are not unfairly penalized and can continue participating in the MSSP without facing undue financial harm.<\/p>\r\n\r\n\r\n\r\n<h3 id=\"industry-reactions-and-support\" class=\"wp-block-heading\">Industry Reactions and Support<\/h3>\r\n\r\n\r\n\r\n<p>The CMS&#8217;s proposal has received strong support from key industry players. Premier Inc., a leading healthcare improvement company, has also expressed its approval. Soumi Saha, Senior Vice President of Government Affairs at <a href=\"https:\/\/premierinc.com\/about\/our-people\/soumi-saha\" target=\"_blank\" rel=\"noopener\">Premier Inc.<\/a>, commended CMS for adopting their recommendation to exclude payments for certain catheter codes from the 2023 performance year. This exclusion protects MSSP ACOs from unjust repercussions due to significant, anomalous, and highly suspect (SAHS) billing activities.<\/p>\r\n\r\n\r\n\r\n<h3 id=\"future-implications-and-policies\" class=\"wp-block-heading\">Future Implications and Policies<\/h3>\r\n\r\n\r\n\r\n<p>The CMS&#8217;s proactive stance on this issue underscores the agency&#8217;s commitment to maintaining the integrity of the MSSP. The agency is looking into permanent policies to address future fraud, waste, and abuse. Additionally, CMS encourages Accountable Care Organizations to report any other irregularities to the CMS Center for Integrity, ensuring that such issues are swiftly addressed.<\/p>\r\n\r\n\r\n\r\n<p>In April, CMS hinted at potential solutions for Accountable Care Organizations&#8217; concerns regarding the ACO REACH program. The agency&#8217;s current action reflects its ongoing efforts to mitigate SAHS billing activities and protect ACOs from unjust financial consequences.<\/p>\r\n\r\n\r\n\r\n<h3 id=\"conclusion\" class=\"wp-block-heading\">Conclusion<\/h3>\r\n\r\n\r\n\r\n<p>The CMS&#8217;s proposal to exclude fraudulent catheter payments from Accountable Care Organizations&#8217; performance assessments for 2023 is a significant step towards protecting these organizations from financial harm. This rule, if finalized, will ensure the sustainability of ACOs and maintain the integrity of the MSSP. The strong support from industry stakeholders highlights the importance of this measure in safeguarding the interests of healthcare providers and organizations.<\/p>\r\n\r\n\r\n\r\n<p><span class=\"ui-provider a b c d e f g h i j k l m n o p q r s t u v w x y z ab ac ae af ag ah ai aj ak\" dir=\"ltr\">Discover the latest <a class=\"fui-Link ___1rxvrpe f2hkw1w f3rmtva f1ewtqcl fyind8e f1k6fduh f1w7gpdv fk6fouc fjoy568 figsok6 f1hu3pq6 f11qmguv f19f4twv f1tyq0we f1g0x7ka fhxju0i f1qch9an f1cnd47f fqv5qza f1vmzxwi f1o700av f13mvf36 f1cmlufx f9n3di6 f1ids18y f1tx3yz7 f1deo86v f1eh06m1 f1iescvh fhgqx19 f1olyrje f1p93eir f1nev41a f1h8hb77 f1lqvz6u f10aw75t fsle3fq f17ae5zn\" title=\"https:\/\/distilinfo.com\/healthplan\/\" href=\"https:\/\/distilinfo.com\/healthplan\/\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\"Link payers&#039; news updates\"><strong>payers&#8217; news updates<\/strong><\/a> with a single click. Follow <a class=\"fui-Link ___1rxvrpe f2hkw1w f3rmtva f1ewtqcl fyind8e f1k6fduh f1w7gpdv fk6fouc fjoy568 figsok6 f1hu3pq6 f11qmguv f19f4twv f1tyq0we f1g0x7ka fhxju0i f1qch9an f1cnd47f fqv5qza f1vmzxwi f1o700av f13mvf36 f1cmlufx f9n3di6 f1ids18y f1tx3yz7 f1deo86v f1eh06m1 f1iescvh fhgqx19 f1olyrje f1p93eir f1nev41a f1h8hb77 f1lqvz6u f10aw75t fsle3fq f17ae5zn\" title=\"https:\/\/distilinfo.com\/healthplan\/\" href=\"https:\/\/distilinfo.com\/healthplan\/\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\"Link DistilINFO HealthPlan\">DistilINFO HealthPlan<\/a> and stay ahead with updates on <strong>medical advancements<\/strong>. Join our community today!<\/span><\/p>\r\n\r\n\r\n\r\n<h3 id=\"fa-qs\" class=\"wp-block-heading\">FAQs<\/h3>\r\n\r\n\r\n\r\n<h4 id=\"1-what-is-the-cm-ss-proposed-rule-about\" class=\"wp-block-heading\">1. What is the CMS&#8217;s proposed rule about?<\/h4>\r\n\r\n\r\n\r\n<p>The CMS&#8217;s proposed rule aims to exclude certain payments for intermittent urinary catheters from the 2023 financial performance assessments for MSSP Accountable Care Organizations to protect them from financial penalties related to fraudulent billing.<\/p>\r\n\r\n\r\n\r\n<h4 id=\"2-why-was-this-rule-proposed\" class=\"wp-block-heading\">2. Why was this rule proposed?<\/h4>\r\n\r\n\r\n\r\n<p>This rule was proposed after discovering unusual billing irregularities suggesting a dramatic increase in payments for certain catheter codes, which could have unjustly penalized ACOs.<\/p>\r\n\r\n\r\n\r\n<h4 id=\"3-how-will-this-rule-impact-ac-os\" class=\"wp-block-heading\">3. How will this rule impact ACOs?<\/h4>\r\n\r\n\r\n\r\n<p>If finalized, the rule will protect ACOs from financial harm due to fraudulent activities, ensuring their continued participation in the MSSP without facing unfair penalties.<\/p>\r\n\r\n\r\n\r\n<h4 id=\"4-who-has-supported-the-cm-ss-proposal\" class=\"wp-block-heading\">4. Who has supported the CMS&#8217;s proposal?<\/h4>\r\n\r\n\r\n\r\n<p>The proposal has received support from the National Association of ACOs (NAACOS) and Premier Inc., both of which praised CMS for taking this proactive measure.<\/p>\r\n\r\n\r\n\r\n<h4 id=\"5-what-are-the-future-implications-of-this-rule\" class=\"wp-block-heading\">5. What are the future implications of this rule?<\/h4>\r\n\r\n\r\n\r\n<p>The CMS is looking into permanent policies to address future instances of fraud, waste, and abuse, ensuring the integrity of the MSSP and protecting Accountable Care Organizations from similar issues.<\/p>\r\n","protected":false},"excerpt":{"rendered":"<p>Introduction ACOs (Accountable Care Organizations) have been concerned about potential financial repercussions due to fraudulent activities within the Medicare system&#8230;. <a href=\"https:\/\/distilinfo.com\/healthplan\/cms-safeguards-acos-protection-rule\/\" style=\"white-space: nowrap;\">Continue Reading <i class=\"fas fa-long-arrow-alt-right\" style=\"vertical-align: middle;\"><\/i><\/a><\/p>\n","protected":false},"author":1,"featured_media":12259,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[1],"tags":[249],"class_list":{"0":"post-12258","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-distilinfo-originals","8":"tag-aco","9":"entry"},"_links":{"self":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/12258"}],"collection":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/comments?post=12258"}],"version-history":[{"count":3,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/12258\/revisions"}],"predecessor-version":[{"id":12264,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/posts\/12258\/revisions\/12264"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/media\/12259"}],"wp:attachment":[{"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/media?parent=12258"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/categories?post=12258"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/distilinfo.com\/healthplan\/wp-json\/wp\/v2\/tags?post=12258"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}