Prevalence of risk-bearing ACOs increasing under Medicare programs, Avalere says

More Medicare ACOs are taking on upside and downside risk under CMS’ Medicare Shared Savings Program and Next Generation ACO Model, according to innovation company Avalere.

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CMS finalizes prior authorization rule for #DME

In a move meant to prevent fraud while protecting access to medically necessary supplies, the CMS on Tuesday issued a final rule that mandates prior authorization for some durable medical equipment prosthetics, orthotics and supplies.

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Clearly the trend for CMS is to create practice guidelines for anything they are concerned is being overused. For this reason, providers need to make sure they are aware of, and their staff are following, the new guidelines or they risk not being reimbursed at best and fines and penalties at the worst.