Medical Billing Services

Medicare Shared Savings Program – 2020

CMS is proposing changes to the Medicare Shared Savings Program (Shared Savings Program) quality performance standard and quality reporting requirements for performance years beginning on January 1, 2021, to align with Meaningful Measures, reduce reporting burden and specialize in patient outcomes.

For the performance year 2020, CMS is proposing to share automatic full credit for CAHPS patient experience of care surveys under the acute and Uncontrollable Circumstances Policy and seeking to discuss modifications to the policy for determining quality performance scores for ACOs impacted by extreme and uncontrollable circumstances for the performance year 2020. For more information, please reference the QPP Fact Sheet: 2021 Quality Payment Program Proposed Rule Overview Fact Sheet.

CMS is additionally proposing to incorporate new evaluation and management and care management CPT and HCPCS codes, including new telehealth codes, within the methodology, need to assign beneficiaries to ACOs, exclude additional codes when delivered in skilled nursing facilities and inpatient care settings, codify in regulation the adjustment that’s made to an ACO’s historical benchmark to reflect any regulatory changes to the beneficiary assignment methodology, and proposing to lower required repayment mechanism amounts for surely renewing ACOs.

As part of CMS’s efforts to scale back burden related to with repayment mechanisms, CMS is proposing to determine a policy that might allow renewing ACOs that wish to continue the use of their existing repayment mechanism to decrease their repayment mechanism amount if a good amount isn’t needed to support their new agreement period.

This proposed approach includes a revised methodology for calculation of repayment mechanism amounts beginning with the application cycle for an agreement period starting on January 1, 2022, and in subsequent years, also as a one-time opportunity for eligible ACOs that renewed their agreement periods beginning on July 1, 2019, or January 1, 2020, to elect to decrease the amount of their repayment mechanisms.

In response to new telehealth code proposals and to update the definition of primary care services to reflect services for cognitive impairment and chronic care management, CMS is proposing to include new evaluation and management and care management CPT and HCPCS codes in the methodology used to assign beneficiaries to ACOs.

In addition, CMS is proposing to exclude certain services furnished in skilled nursing facilities from the assignment methodology when provided by clinicians in FQHCs and RHCs and to modify the definition of primary care services to exclude advance care planning CPT code 99497 and the add-on code 99498 when billed in an inpatient care setting. CMS is also codifying in regulations our policy of adjusting an ACO’s historical benchmark to reflect any regulatory changes to the beneficiary assignment methodology.

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