Data / Federal rules / 2024-14601
Medicare Program: Mitigating the Impact of Significant, Anomalous, and Highly Suspect Billing Activity on Medicare Shared Savings Program Financial Calculations in Calendar Year 2023
The Centers for Medicare & Medicaid Services published this proposed rule in the Federal Register on July 3, 2024. Comments closed on July 29, 2024.
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What the agency says
This proposed rule addresses policies for assessing performance year (PY) 2023 financial performance of Medicare Shared Savings Program (Shared Savings Program) Accountable Care Organizations (ACOs); establishing benchmarks for ACOs starting agreement periods in 2024, 2025, and 2026; and calculating factors used in the application cycle for ACOs applying to enter a new agreement period beginning on January 1, 2025, and the change request cycle for ACOs continuing their participation in the program for PY 2025, as a result of significant, anomalous, and highly suspect billing activity for selected intermittent urinary catheters on Medicare Durable Medical Equipment, Prosthetics, Orthotics & Supplies (DMEPOS) claims. Under the Shared Savings Program, providers of services and suppliers that participate in ACOs continue to receive traditional Medicare fee-for-service (FFS) payments under Medicare Parts A and B, but the ACO may be eligible to receive a shared savings payment if it meets specified quality and savings requirements. ACOs participating in two-sided models may also share in losses.
Key facts
- Document number
- 2024-14601
- Type
- Proposed rule
- Action
- Proposed rule
- Agency
- Health and Human Services Department; Centers for Medicare & Medicaid Services
- Published
- July 3, 2024
- Comments due
- July 29, 2024
- Dates
- To be assured consideration, comments must be received at one of the addresses provided below, by July 29, 2024.
- Docket
- CMS-1799-P
- Regulation ID (RIN)
- 0938-AV20
- Code of Federal Regulations
- 42 CFR 425
- Topics
- Administrative practice and procedure; Health facilities; Health professions; Medicare; Reporting and recordkeeping requirements
- Pages
- 13
Other documents from the Centers for Medicare & Medicaid Services
Everything from the Centers for Medicare & Medicaid Services · Rules on administrative practice and procedure · Rules on health facilities · Rules on health professions · Published in July 2024
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