CMS Posts Updated Questions and Answers on Exclusivity in Accountable Care Organizations (ACOs) – Specialists Impacted; ASCRS Working to Resolve Issue
As we previously reported, ASCRS, along with representatives from the AMA and several physician organizations, met with CMS officials recently to address potential problems regarding the final rule on provider exclusivity under the Medicare Shared Savings Program. Although the final ACO rule had been widely interpreted as allowing specialty physicians to practice in multiple ACOs as long as patients are not assigned to the ACO based on primary care visits billed by that specialty physician, if a practice (TIN) bills any E & M — regardless of specialty — they may only participate in one ACO. This was verified at the meeting. As a result of the meeting, which alerted CMS officials to potential and existing problems, CMS has updated its list of ACO Questions and Answers to address this and other issues. However, ASCRS and the medical community are still working with CMS to resolve this issue, and we will be providing you with further updates.
This week, as a follow-up to an earlier meeting with CMS spearheaded by ASCRS, a task force of medical specialty organizations, including ASCRS, American Medical Association (AMA), Medical Group Management Association (MGMA), American College of Physicians (ACP), and the American Association of Medical Colleges (AAMC) met with CMS officials, at their request, to outline proposed alternatives to the current ACO exclusivity policy regarding physician/group participation in Multiple Medicare ACOs.