HEALTH CARE Compliance & engagement Solutions

DATE: December 4, 2017

Re: OIG/GSA Exclusion screening requirements for medicare acos

While there is no specific requirement in the Medicare Shared Savings Program Final Rule, or in the Next Generation ACO Model Participation Agreement for the screening to be completed monthly, Wilems Resource Group, LLC recommends that all Shared Savings Program and Next Generation ACO’s complete the screening upon hire or contracting and monthly thereafter in order to avoid making payments to an individual or entity who has been excluded from federal health care programs.  Click here to read our rationale and recommendations. 


DATE: October 18, 2017

RE: Voluntary Alignment for NextGen ACOs

Wilems Resource Group has received confirmation from CMMI that NextGen ACOs cannot utilize voluntary alignment selections made on during CY2017 for the alignment of beneficiaries in PY3/CY2018.  A policy change is under consideration that may incorporate the online selections for use in CY2018 for alignment of beneficiaries in CY2019.


DATE: August 8, 2017

RE: Good News for ACOs - Data Use Agreement 

Kimberly has been working with NAACOS and CMS to help define what is and is not permissible under the Data Use Agreement (DUA) signed by ACOs with CMS.  While CMS has said that they are working to help further clarify these requirements, we were able to obtain some additional guidance.

An ACO can share aggregated findings outside the ACO from the CMS Claims and Claims Line Feed files (e.g., emergency department visits rates by county or admission rates by hospital), provided the findings are compliant with the cell suppression and other rules around disclosure of findings in Section 9 of the DUA.  Based on this assessment, an ACO could share the following reports:

  • Report showing readmission rates of various SNFs where all sites shown have numerators of more than 10 readmissions.
  • Report profiling various neurology groups’ MRI utilization rates, provided each group had a numerator containing more than 10 referrals.
  • Report showing average cost per patient for various home health agencies, provided the average consists of 10 or more patients.
  • Report showing average costs for beneficiaries with a specific diagnoses or billing code.