AMERICA’S ACO INFORMATION FOR PROVIDERS
Why was AMERICA’S ACO Formed?
Central Florida Physicians Trust (AMERICA’S ACO) was formed in 2012 as an MSSP ACO to proactively respond to federal initiatives by CMS aimed at coordinating patient care to reduce system waste and achieve better patient outcomes. The formation of FTP allows participating providers to embrace innovative CMS payment models that reward efficient quality care, and in efforts to preserve financial solvency and independence in the midst of paradigmatic change and reform in the current value-based healthcare environment.
As a healthcare provider, must I participate in a Medicare Shared Savings Program ACO?
Participating in an ACO is purely voluntary for providers.
What type of Medicare Shared Saving Program ACO is AMERICA’S ACO?
FTP is a level E two-sided risk Medicare Shared Savings Program ACO under the new “Pathways to Success” Program. The level E ACO status qualifies for participation in an advanced alternative payment model under the Quality Payment Program. Providers participating in an advanced alternative payment model are eligible to receive additional incentive payments from CMS and are exempt from participation in merit-based incentive payment system, or MIPS, reporting requirements and potential downward payment adjustments.
Why should I consider participating with Central Florida Physicians Trust (AMERICA’S ACO)?
Access to a network of over 1,000 Independent Specialists that provide clinically integrated services to Medicare and commercial patients aligned with AMERICA’S ACO.
Can I participate in multiple Medicare Shared Saving Program ACOs?
Each taxpayer identification number or CMS Certification Number (CCN) billing Medicare for primary care services (as defined in the MSSP regulations at §425.20) must be exclusive to one MSSP ACO’s certified list of ACO participants. Exclusivity in Central Florida Physicians Trust only applies to Medicare FFS and does not preclude you or your practice from participating in other IPA or payer network arrangements.
According to CMS, the following provider types must be exclusive to a single ACO:
Are all providers who bill Medicare under a single TIN required to participate in an ACO or can some decide not to participate?
Medicare requires a list of ACO participant TINs in order to attribute a given provider, practice, or hospital to an ACO.
Therefore, CMS requires all providers who bill Medicare under a single TIN to agree to participate in the ACO.
How are shared savings distributed in AMERICA’S ACO?
Central Florida Physicians Trust retains 30% of shared savings for administrative and operational expenses costs and reinvestment in the growth of the ACO. The remaining 70% is distributed to AMERICA’S ACO primary care participating providers.
How are Medicare beneficiaries assigned to AMERICA’S ACO?
Beneficiaries (patients on Fee for Service or “Original” Medicare) are assigned to Central Florida Physicians Trust if they receive the plurality of their primary care services from PCPs (physicians or non-physician practitioners) with our ACO.
How does participation in AMERICA’S ACO impact Medicare Fee for Service payments to individual practices or practitioners?
Providers continue to submit claims to Medicare under their existing Tax ID and NPI numbers, and Medicare reimburses on a fee-for-service basis as they have in the past. For AMERICA’S ACO participants, CMS provides routine reporting for assigned beneficiaries including information on utilization, cost, and quality to the ACO to determine performance against the established benchmark. AMERICA’S ACO disseminates the data throughout a performance year and offers feedback on various measures to assist in the effort of enhancing performance and achieving savings.
What is the impact on Medicare Beneficiaries if a provider chooses to participate in AMERICA’S ACO?
Fee-for-service Medicare beneficiaries treated by providers who are participating in AMERICA’S ACO maintain all of their Medicare rights, including the right to choose any doctors and providers that accept Medicare. Whether a provider chooses to participate in an ACO or not, their existing Fee-for-Service Medicare Patients’ may continue to see them.