With the publication of the 2022 Physician Fee Schedule Final Rule on November 2, 2021, Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs) breathed a collective sigh of relief. In addition to some positive administrative modifications, CMS finalized several significant changes to the quality policies for ACOs. CMS also attempted to address continuing concerns regarding the use of electronic Clinical Quality Measures (eCQMs) as the standard for quality measurement, but there are still lingering questions regarding full eCQM implementation that go unanswered.
Administrative Changes
CMS finalized several changes that alleviate some of the burden in administering an ACO. First, CMS added to the primary care services list for the purpose of beneficiary assignment to the ACO. The code set now includes Chronic Care Management (CPT Code: 99437), Principal Care Management (99424, 99425, 99426, and 99427), as well as two G-codes: G2122 (prolonged office or other outpatient E/M service) and G2252 (communication technology-based service). This new code set will capture more patient interaction and possibly assign more patients to ACOs.
CMS also updated the requirements to provide each beneficiary a written notice of the provider’s participation in the ACO. Previously, every ACO had to provide the written notice “prior to or at the first primary care visit of the performance year* ” to every Medicare beneficiary, even if they were not assigned to the ACO. CMS changed this for those ACOs that choose prospective assignment. These ACOs are only required to provide notice to the beneficiaries on their prospective assignment list. Unfortunately, those ACOs still utilizing preliminary prospective assignment with retrospective reconciliation must notify every Medicare patient on or before their first primary care visit.
For ACOs taking on risk, CMS finalized policy reducing the amount required to retain for a repayment mechanism. ACOs are required to hold an amount either in a letter of credit, escrow account, or surety bond to demonstrate its ability to repay CMS in the event the ACO incurs losses. The new amounts required have been cut in half compared to previous policy. CMS now requires that the amount be the lesser of either: (1) 0.5% of the total per capita Medicare Part A and B FFS expenditures for the assigned population or (2) 1.0% of the total Medicare Parts A and B revenue of the ACO Participants.
Finally, CMS also removed several of the application requirements. These include providing fully executed copies of ACO Participation Agreements between the ACO and the ACO Participant and submitting a sample copy of that same Participation Agreement. This will streamline the application and renewal process for the future.
*42 C.F.R. 425.312
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