As pay-for-performance programs continue to expand in both scale and scope across the US health care system, the amount of administrative and clinical resources necessary to participate in these programs has correspondingly grown. Participating providers have been faced with increasingly burdensome reporting requirements due to a lack of standardization of quality measures and reporting mechanisms among the various payors. This lack of cohesion has led to significant compliance costs for providers seeking to participate and accurately report quality achievements to the various programs.
Accountable Care Organization
Joyce Branda, the Deputy Assistant Attorney General for the Commercial Litigation Branch of the Department of Justice (DOJ), gave the keynote address on September 28, 2015, at the American Health Lawyers Association Fraud and Compliance Forum in Baltimore, providing conference attendees with an update from DOJ. Her speech identified various key issues for DOJ, as well as areas in which the health care industry can expect to see increased scrutiny in the coming year.
On June 9, 2015, the Centers for Medicare and Medicaid Services (CMS) published a final rule in the Federal Register making changes to the Medicare Shared Savings Program for Accountable Care Organizations (ACOs). These changes were intended to encourage increased participation by hospitals, rural health centers, federally qualified health centers, physicians, and other eligible health care providers in the Shared Savings Program
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