Aco Participant List And Participant Agreement Guidance


After enrolling in the program and after the conclusion of the participation agreement with the CMS, the ACO must certify the completeness and veracity of its list of ACO participants. We established the ACO`s historical scale at the beginning of the contract period based on the population allocated for each of the three reference years, using the ACO-certified ACO participant list. The ACO must submit a new list of certified ACO participants at the beginning of each new performance year. As of July 1, 2019, a CAO or ACO participant will receive a standardized written notification to each recipient, before or during the first primary supply visit of the delivery year, as defined by the CMS. In addition, a ACO participant publishes signs in their facilities and in environments where recipients receive primary care services and provides, on request, standardized written communications. The notification should contain information on: The Medicare Shared Savings Program coordinates participation in the PQRS as part of the Shared Management Program by submitting annually the certified list of TIN participating in the ACO to the PQRS program. In addition, when a CAO operates an incentive program (GDP), ACO participants or their ACO participants must also notify service fee recipients (FFS) that they are operating a GDP. CMS provides ACOS with population and financial performance information attributed at the beginning of the contract period and routinely during the year of delivery. ACOs must request to receive monthly claim and claim line feed (CCLF) files through Medicare FFS recipients who have not refused to submit their data. Eligible professionals who charge after one year through an ACO participant who joins an ACO cannot qualify this year for a PQRS incentive through the shared savings program.

Instead, these legitimate professionals may strive to participate in one of the traditional individual reporting or PQRS group options and, if the program requirements are met, be eligible for an incentive to the PQRS for this year. Eligible professionals billed through the new added ACO participant can qualify for a PQRS incentive under the ACO-based Shared Reporting Program for the next performance year.