ACOs eligible for the Medicare Shared Savings Program (MSSP) under the Affordable Care Act (ACA) of 2010 must meet the following criteria:
The 2015 Medicare final rule and three other related documents involving five federal agencies amplify these ACA requirements.
What are the types of financial incentive models for ACOs?
There are three tiers: upside-bonus-only shared savings, a hybrid of limited-upside and limited-downside shared savings and penalty, and full-upside and full-downside capitation.
ACOs require collaboration, referrals, reductions in unnecessary care, and sharing of revenues among sometime competitors.
A properly configured ACO should be successful in navigating this legal minefield. The principal bodies of law affecting ACOs are:
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