ACO Update: Impact of New Rule

Event Information
Product Format
Prerecorded Event
60 minutes
Product Description

Understand How Medicare’s Newly Issued Rule Promises More Flexibility to ACOs


With many of the 400 accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) nearly completing first three year term, participants have been debating whether to continue participation. To help keep ACOs going, Medicare is promising more flexibility under a newly issued rule. For providers that are in or outside ACOs, these changes must be evaluated carefully to determine if the obligations are worth the financial risk.

Among the changes, CMS is offering a new option for groups to take on more financial risk of patient care. Further, existing ACOs will have the option to maintain their existing risk levels for a new term. Also promised is future guidance on benchmarking and rebasing issues that have been sources of contention for many providers.

Although many ACOs have been approved already, Medicare may grant new approvals in the near future based on the new rules. It will be helpful to examine the prior rounds of approvals and understand the characteristics of successful applicants. At the same time, examining submissions by unsuccessful applicants will highlight the challenges that need to be overcome for new participants. The new rules also require existing ACOs to re-examine such issues as formulas for allocating bonuses and for addressing payments for activities outside of the MSSP.

Join expert speaker Wayne J. Miller, Esq. in this session to discuss topics involving new rules, and issues involving new and existing ACOs.

Session Highlights:

  • How the new rule impacts ACOs on different tracks
  • What are membership and administrative requirements of ACOs
  • Keeping primary and specialist providers in ACOs under the new standards
  • Addressing ACO “growing pains”
  • What are ACO waivers and do you need them?
  • Addressing potential fraud and abuse and Stark law issues
  • Keys to success or rejection by CMS

 Wayne will cover:

  • The pertinent points related to ACOs
  • Medícare ACO standards
  • Attributes of ACOs and ACO Members
  • Approved ACO types under Medícare
  • Overview of Supporting Parties, Structure, Management and Governing Body
  • Key Legal ACO documents
  • A look at provider obligations and assignments
  • Summary of new ACO rules
  • The impact on compliance e.g. Participation contract
  • A discussion of F&A, Stark compliance, and CMP waivers
  • Discussion of commercial ACOs
  • Operational and participant issues

Who should attend

ACOs, Hospitals, Clinics, Practice Managers, Physicians, Medical Groups, Health Care Consultants

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About Our Speaker

Wayne J. Miller - Healthcare Compliance Expert

Wayne J. Miller, Esq., is a founding partner of the Compliance Law Group, Los Angeles, a law firm focused on health care industry legal compliance for clients nationwide. Wayne has practiced healthcare business and regulatory law throughout his 30-year career. His firm represents a wide range of healthcare industry clients throughout the nation. He is a frequent speaker for The Coding Institute national teleconferences on healthcare reimbursement, transactional and regulatory...   More Info
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