Medical Billing Outsourcing

Medicare Beneficiaries

Recent reports suggest that the CMS is trying to improve provider and patient participation in Accountable Care Organizations (ACOs). They are planning to improve participation by automating the process to pair patients with the doctors who are participating in the ACO models. This means that in the coming weeks, Medicare beneficiaries will be able to go to a website that has their enrollment details and list their primary care doctor.

“ACOs have told us they prefer to know with more certainty at the beginning of the performance year what beneficiaries the CMS will hold them accountable for,” Dr. Terri Postma, a medical officer at the Center for Medicare, said in a meeting with the Advisory Panel of HHS about Outreach and Education.

Providers complain about the current process as it retroactively assigns patients to ACOs. This means that the CMS will tell a doctor at the end of the year which of their patients will be considered to find success in improving the quality of care while decreasing the costs. As per experts, this is done to make sure that the doctors do not select their healthiest patients to take part in the ACO programs.

The idea to electronically pair ACOs and beneficiaries was proposed for the first time in 2017 physician pay rule that was released last year. The news was greeted by health care providers with a mixed reaction at that time. For instance, the American Academy of Family Physicians (AAFP) noted that Medicare beneficiaries might not have access to computers or may not have the idea about navigating the website to provide the details.

Medical Billing India

Accountable Care Organizations

In fact, the medical group even urged the CMS to take into account two options. First to run a pilot program and find if the process would work, and secondly, to use claims that are submitted by the providers to assign Medicare beneficiaries. AAFP also suggested CMS to make a strategy to inform users about the benefits of ACOs and the importance and need of picking their own doctor.

Jeff Spight, who is the president of Collaborative Health Systems, which is a branch of Universal American that operates ACOs, said that he is not sure if the latest pairing initiative will be successful. He said that an earlier ACO campaign that asked different Medicare enrollees to choose a doctor via a mailed letter was unsuccessful, as most of the beneficiaries were unable to understand the notice.