CMS: Medicare Program: Mitigating the Impact of Significant, Anomalous, and Highly Suspect Billing Activity on Medicare Shared Savings Program Financial Calculations in Calendar Year 2023

Federal Register

Sep 27, 2024

Notice of final rule from the Centers for Medicare & Medicaid Services (CMS) addressing policies for assessing performance year (PY) 2023 financial performance of Medicare Shared Savings Program (Shared Savings Program) Accountable Care Organizations (ACOs) in light of significant, anomalous, and highly suspect (SAHS) billing activity for selected intermittent urinary catheters on Medicare Durable Medical Equipment, Prosthetics, Orthotics & Supplies (DMEPOS) claims. Among other things, this rule establishes benchmarks for ACOs starting agreement periods in 2024, 2025, and 2026, financial calculations 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. These regulations are effective October 15, 2024.

Accountable Care Organizations · Healthcare business and finance · Legislation and regulations · Medicare · Reimbursement and payment models