The Centers for Medicare & Medicaid Services (CMS) announced in the Federal Register a new opportunity for smaller Accountable Care Organizations (ACOs) to participate in the Medicare Shared Savings Program (MSSP) through the creation of the Advance Payment Model program.
The Advance Payment Model is designed for physician-based and rural providers who have come together voluntarily to give coordinated, high-quality care to the Medicare Fee-For-Service (FFS) patients they serve. In order to qualify for this payment model ACOs must meet the following criteria:
- ACOs without any inpatient facilities and that have less than $50 million in total annual revenue; and
- ACOs in which the only inpatient facilities are critical access hospitals and/or Medicare low-volume rural hospitals and that have less than $80 million in total annual revenue.
Even if an ACO qualifies as one of the two types of organizations described above, it will be ineligible to participate in the Advanced Payment Model if it is co-owned by a health plan.
Through the Advance Payment Model, selected ACOs will receive an advance on the shared savings they are expected to earn to compensate for both fixed and variable start-up costs. ACOs will receive three types of payments that will be paid back to the MSSP once savings begin:
- An upfront, fixed payment;
- An upfront, variable payment based on the number of its historically-assigned beneficiaries; and
- A monthly payment of varying amount depending on the size of the ACO, which is based on the number of historically-assigned beneficiaries it serves.
From August 1-September 19, CMS will accept web-based applications for a new round of Advance Payment Model ACOs that would begin January 1, 2013.
For more information, visit the CMS website.
