MSSP is an original Medicare incentive program created by CMS. This program is a voluntary program that encourages groups of doctors, hospitals, and other health care providers to come together as an ACO(Accountable Care Organization) to give coordinated, high quality care to their Medicare beneficiaries.By lowering healthcare costs for their assigned beneficiaries, ACO’s are eligible for a portion of those savings.
Beneficiaries can be assigned in two ways. Patients can first Voluntarily Align themselves to an ACO by selecting an ACO provider as their primary physician through my.medicare.gov. All other beneficiaries are assigned by Claims Based Assignment, where patients are assigned to the ACO which provided the most primary care services (measured by Medicare-allowed charges). Regardless of how the beneficiary is assigned, he or she retains freedom of choice of providers inside and outside of the ACO.
The method of distribution amongst its providers is up to the individual ACO. CCACO retroactively assigns patients to doctors first based on the primary care physician who performed the last Annual Wellness Visit and then based on most number of visits with a provider in the previous years.
CMS first considers Primary Care Provider for beneficiary assignment. CMS defines the following specialties to be Primary Care Provider: Internal Medicine, Family Medicine, Geriatric Medicine, Pediatric Medicine, General Practice, Nurse Practitioners, Physician Assistants;
For beneficiaries that have not visited any Primary Care Provider, CMS uses the following specialties for assignment: Cardiology, Osteopathic Manipulation, Neurology, OB/GYN, Sports Medicine, Physical Medicine and Rehabilitation, Psychiatry, General Psychiatry, Pulmonary Disease, Nephrology, Endocrinology, Multispecialty clinic or group practice, Hematology, Hematology/Oncology, Preventive Medicine, Neuropsychiatry, Medical Oncology, Gynecology Oncology
These are Original Medicare Patients that have visited your practice in the past year, but are not assigned to our ACO because we did provide plurality of service (see above). By bringing them in for services such as Annual Wellness Visits or having them Voluntarily Align by selecting you as their primary doctor, we may be able to add them to our patient panel.
Since MSSP only governs Original Medicare patients, ACO participation will not affect any plans involving Medicaid HMO, Medicare Advantage, or commercial insurances.
MSSP只覆盖初始联邦医疗保险病人。参与ACO不会影响Medicaid HMO、Medicare Advantage或商业保险。
ACO participation occurs at TIN level. Any TIN that bills primary care services to Medicare may only join one ACO. TINs that do not bill primary care services may join multiple ACOs. Individual providers may participate in multiple ACOs given that they bill under multiple TINs that are participants of different ACOs.
CMS denotes the following CPT/HCPCS codes as primary care services: 96160-96161, 99201–99205, 99211–99215, 99304–99306, 99307–99310, 99315–99316, 99318, 99324–99328, 99334–99337, 99339–99340, 99341–99345, 99347–99350, 99354-99355, 99484, 99487, 99489, 99490, 99492-99494, 99495–99496, 99497-99498, G0402, G0438, G0439, G0442-G0444, G0463 (for ETA hospitals), and G0506.
CMS将以下CPT/HCPCS代码指代的项目界定为初级医疗服务：96160-96161, 99201–99205, 99211–99215, 99304–99306, 99307–99310, 99315–99316, 99318, 99324–99328, 99334–99337, 99339–99340, 99341–99345, 99347–99350, 99354-99355, 99484, 99487, 99489, 99490, 99492-99494, 99495–99496, 99497-99498, G0402, G0438, G0439, G0442-G0444, G0463 (for ETA hospitals), and G0506
SOMOS ACO was formed by CCACO and Balance ACO. CCACO is the #3 ACO in NYS, earning $2mm in shared savings incentives in 2017. Balance ACO is the #1 ACO in NYS, earning $13mm in shared savings incentive in 2017. CCACO has historically participated in the Track 1 Model (upside, shared savings only). CCACO and Balance ACO are preparing to continue participation in the MSSP as SOMOS ACO in the Track 3/Enhanced Model (upside savings/ downside risk sharing). Potential downside risk will be taken on by the organization, not the individual provider.
SOMOS ACO由CCACO和Balance ACO组成。CCACO是纽约州第三个责任医疗组织，2017年取得200万美元的共享节省激励。Balance ACO是纽约州第一个责任医疗组织，2017年赚取1300万美元。CCACO过去参与的是“模式一”（共享节省）。CCACO和Balance ACO合并成SOMOS ACO后，计划参与进联邦医疗保险共享节省项目的“模式三”（共享节省和共享风险）。潜在的风险会由组织而非医生个人承担。
Yes, you will continue to remain a CCACO member, but to continue your participation in the Medicare Shared Savings Program, you must sign a PPA with SOMOS ACO. You will participate in the MSSP through SOMOS ACO as a CCACO member.
是，你会维持CCACO会员身份，但是为了继续参与进联邦医疗保险共享节省项目（MSSP），你必须与SOMOS ACO签署一份PPA。你会作为CCACO会员，通过SOMOS ACO参与MSSP。
You will receive the benefits of MSSP participation, such as receiving shared savings incentives, 5% increase in Medicare payments, exemption from reporting requirements, and potential participation in beneficiary incentive programs. You will lose these benefits if you do not sign a PPA with SOMOS ACO.
Yes. As a participant in SOMOS ACO, you are supported by a team of MACRA experts who will help you successfully meet all requirements. You will be joining a team that has consistently achieved high quality scores.
The risk scores displayed on the dashboard is based on the CMS-HCC model for risk adjustment. The model predicts patient expenditure based on the diagnosis codes that were coded in the previous year and is used by CMS to determine benchmarks for Medicare Advantage. It is also a component of our ACO benchmark, thus it is important for providers to properly code to ensure their patients receive the correct risk adjustment.
Dropped off codes are ICD codes that were coded in the previous calendar year but have not been coded this year. If the codes are still medically appropriate, they should still be coded even if the office visit is not for that particular condition. For example, a patient with a disability (e.g amputation) should have the ICD coded every year.