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Accountable Care News: August 2015

Accountable Care News: August 2015, Thought Leaders’ Corner

Accountable Care News approached David Fairchild, MD, Director with BDC Advisors to discuss: In the MSSP ACO Final Rule, CMS finalized new regulations that govern the assignment of Medicare fee-for-service beneficiaries to an ACO participating in the MSSP. How did they do?

David Fairchild, MD responded:

“CMS has been listening to the comments they got on the final rule. First they have expanded the definition of primary care to include certain CPT codes that are also associated with transitional and critical care services which will make it easier to assign FFS beneficiaries to the ACO. Second, they agreed to include in their assignment methodology claims for services provided by nurse practitioners and physician assistants in the count of primary care services as long as they have at least one primary care service visit from a physician who is in the ACO. This will cheer Medical Home advocates. Finally they defined primary care services more accurately by excluding the claims of certain specialists—mainly surgeons—who may bill for services thought of as part of primary care—but who rarely if ever provide primary care services. This should please the specialists.

All of these changes should make the assignment of fee-for-service Medicare beneficiaries to the ACO clearer and less controversial.”


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