Accountable Care Organizations (ACO) – What You Need to Know About Setting Up an MSSP ACO

Accounting Care Organizations are required to submit the names of ACO participants. Examples of such participants include a group and solo practice, a pharmacy, an acute care hospital, a Critical Access hospital, a federally qualified health and a rural health center, and other such entities that are enrolled with Medicare and bill Medicare for services.

Compliance

A group practice that fulfils the criteria of Accounting Care Organizations must have all its ACO providers and suppliers that bill under its practice to agree to participate in the MSSP. All arrangements or agreements between the ACO and its participants and providers or suppliers, and other entities or individuals carrying out services related to ACO functions must comply with the conditions of the Medical Shared Services Program.

Quality

All Medicare-enrolled suppliers and providers that bill Medicare directly are eligible to become an ACO participant. However, a provider that bills Medicare directly, except billing for primary care services is not permitted to form an Accounting Care Organizations except when joined by other such providers or suppliers that bill directly for primary care services. These services form the basis for sending patients to the ACO in order to evaluate quality of performance.

Clearance

As a part of the application process, when an ACO applies for participation in the MSSP, it must have prior agreements with every ACO participant at that time. It will be required to certify that the ACO and its participants, providers, and suppliers have an agreement to become accountable for the overall care, quality, and cost of the Medicare beneficiaries assigned to the ACO.

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It is the ACO’s responsibility to ensure that every participant, provider and supplier, and other related individuals and entities comply with all the requirements of the program. For more information, watch this informative video on Accounting Care Organizations.