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January 25, 2018

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CMS Eases ACO Participation Rules for Safety-Net Providers

February 3, 2012:

Trudy Whitehead, Clinical/Technical Editor

One of the key modifications the Centers for Medicare and Medicaid Services made in the final rule for the Medicare Shared Savings Program was to ease participation requirements for rural providers.

It will now be easier for small, isolated entities (safety-net providers) to form or join accountable care organizations (ACO). The final rule on ACOs, published November 2, 2011, allows federally qualified health centers (FQHC) and rural health clinics (RHC) to become their own ACOs or to join with other providers in forming an ACO. To track quality of care and financial performance, CMS has added revenue center codes that can be submitted on claims for primary care services. In addition, FQHCs and RHCs must submit the national provider identifier codes for their primary care physicians.

CMS decides which beneficiaries are assigned to any given ACO based largely on which physicians and nonphysician practitioners provide most of the primary care services for certain beneficiaries.

Critical access hospitals (CAH) that have opted to bill for their outpatient services under Method II may form an ACO as long as they meet all the other eligibility requirements (must serve at least 5,000 Medicare beneficiaries, participate for three years, and have an appropriate governing board). CAHs paid under Method I (they do not bill for their physicians’ primary care services) may not form their own ACO but may join with other ACO members to participate in the Shared Savings Program.

For more information about the Shared Savings Program and rural providers, refer to the November 2, 2011, Federal Register.


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