Data / Federal rules / 2024-22054
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 final rule in the Federal Register on September 27, 2024. It took effect on October 15, 2024.
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What the agency says
This final 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. In this final rule, we respond to public comments we received on the proposal to mitigate the impact of significant, anomalous, and highly suspect billing activity on Medicare Shared Savings Program financial calculations in calendar year (CY) 2023.
Key facts
- Document number
- 2024-22054
- Type
- Final rule
- Action
- Final rule
- Agency
- Health and Human Services Department; Centers for Medicare & Medicaid Services
- Published
- September 27, 2024
- Takes effect
- October 15, 2024
- Dates
- These regulations are effective on October 15, 2024.
- Docket
- CMS-1799-F
- 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
- 21
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 September 2024
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