For Providers
Find information on what the Shared Savings Program means for health care providers and suppliers.
Shared Savings Program and Providers
Participation in a Shared Savings Program Accountable Care Organization (ACO) creates incentives for health care providers to work together to treat an individual patient across care settings, including doctor’s offices, hospitals, and long-term care facilities.
For more information on Shared Savings Program ACOs, visit the About the Program webpage.
ACO Providers and Suppliers
Eligible ACO providers and suppliers that may participate in the Shared Savings Program include:
- ACO professionals in group practice arrangements
- Networks of individual practices of ACO professionals
- Partnerships or joint venture arrangements between hospitals and ACO professionals
- Hospitals employing ACO professionals
- Critical Access Hospitals (CAHs) that bill under Method II
- Federally Qualified Health Centers (FQHCs)
- Rural Health Clinics (RHCs)
- Teaching hospitals that have elected to receive payment on a reasonable cost basis for the direct medical and surgical services of their physicians
Care Coordination
Health care providers have reported that a lack of information is a barrier to improving care coordination. While a provider may know about the services they provide to the beneficiary, they often do not know about all the services the beneficiary receives from other health care providers.
To better treat patients and to coordinate their care, Shared Savings Program ACOs may request Medicare claims information about their patients from CMS.
Telehealth
With the passage of the Bipartisan Budget Act of 2018, new flexibilities were granted for physicians and practitioners in certain ACOs in the delivery of services through telehealth for dates of service on or after January 1, 2020. Providers and suppliers in ACOs that are in a two-sided risk track and that choose prospective assignment may bill for certain services without the geographic limitations that usually apply to fee-for-service telehealth coverage. Also, the home of the beneficiary may qualify as an originating site.
See the Shared Savings Program Telehealth Fact Sheet (PDF); for details including which telehealth services are part of the expanded benefit, and how to bill them.
CMS ACO Learning System
Since 2012, CMS has supported ACOs in their efforts to improve the delivery of care for their assigned beneficiary populations through model-specific learning systems. These learning systems provide ACOs with a forum in which they can collaborate with and learn from one another. Visit CMS Innovation Center ACOs webpage for the most current Toolkits and Case Studies.
Provider Participation
To participate in the Shared Savings Program, Medicare-enrolled providers and suppliers must form or join an ACO, and the ACO must apply and be accepted to the Shared Savings Program. Providers and suppliers may contact other ACO participants in the region, state, or national professional associations to investigate opportunities to join an ACO. ACOs must have at least 5,000 Medicare fee-for-service (FFS) beneficiaries assigned to their ACO in each benchmark year to be eligible for participation in the Shared Savings Program.
- For Shared Savings Program ACO locations and contact information, refer to Program Data.
- For more information on eligibility criteria, refer to Program Statutes & Regulations.
- Frequently asked questions about affiliating with an ACO as an “Other Entity (PDF),” instead of an ACO participant.
Exclusivity Rule
Within the Shared Savings Program:
Any ACO participant, as identified by the taxpayer identification number (TIN), that has a specialty used in assignment (reference 42 CFR 425.402), and bills Medicare for primary care services must be exclusive to a single Shared Savings Program ACO. However, individual practitioners, identified by individual National Provider Identifiers (NPIs), are free to participate in multiple ACOs if they bill under several different TINs.
Among Medicare shared savings initiatives:
During a performance year, a Medicare-enrolled TIN can participate in only one Medicare shared savings initiative, including certain CMS Innovation Center initiatives (reference the list in the Other CMS Innovation Center Initiatives below).
Empowering Patients to Make Decisions About Their Healthcare
Voluntary alignment is the process that lets Medicare FFS beneficiaries select, or “voluntarily align” with, a primary clinician. ACOs must notify beneficiaries of their ability to, and the process by which, he or she may identify or change the person he or she chose for the purposes of voluntary alignment.
Medicare FFS beneficiaries can log into Medicare.gov and choose their primary clinician, the health care provider they believe is responsible for coordinating their overall care. The Shared Savings Program will use the eligible beneficiary’s selection of a primary clinician on Medicare.gov to take priority over the claims-based assignment methodology. For more information, refer to the following resources:
- Beneficiary Fact Sheet Choose Your Primary Clinician on Medicare.gov (PDF) (Spanish translation (PDF))
Program Intersection
There are several Medicare initiatives that aim to promote quality improvement while lowering the growth in health care expenditures. Although these programs are separate and distinct, they interact in key areas. The following programs intersect with the Shared Savings Program.
Quality Payment Program
The Quality Payment Program improves Medicare by helping providers focus on care quality and the one thing that matters most—making patients healthier.
The Quality Payment Program has two tracks from which clinicians can choose:
- Advanced Alternative Payment Models (APMs): Include Shared Savings Program Track 2, Track 3, Level E of the BASIC track, ENHANCED track, and the Medicare ACO Track 1+ Model.
- Merit-Based Incentive Payment System (MIPS): Includes MIPS eligible clinicians who are in ACOs participating in the Shared Savings Program under Track 1, and Levels A, B, C, and D of the BASIC track.
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To view your Quality Payment Program (QPP) participation status by performance year, visit the QPP Participation Status Lookup Tool and enter your 10-digit National Provider Identifier number. Questions about the QPP Participation Status Lookup Tool may be directed to the QPP Service Center at 1-866-288-8292, (TTY) 1-877-715-6222 or by email at [email protected].
To learn more about Quality Payment Program and Shared Savings Program interaction, visit the Quality Payment Program Resource Library webpage.
Other CMS Innovation Center Initiatives
Shared Savings InitiativesACO participants cannot participate in multiple Medicare initiatives involving shared savings, including:
- Next Generation ACO Model
- Comprehensive End-Stage Renal Disease (ESRD) Care (CEC) Model
- Independence at Home Demonstration with a shared savings arrangement (The Patient Protection and Affordable Care Act Sec. 3024)
Medicare and the CMS Innovation Center may introduce additional programs, demonstrations, or models with a Medicare shared savings component in the future.
Non-Shared Savings InitiativesShared Savings Program ACOs can participate in CMS Innovation Center initiatives that do not involve shared savings. These include:
- Financial Alignment Initiative
- Comprehensive Primary Care Plus (CPC+)
- Bundled Payments for Care Improvement (BPCI) Initiative
For a complete list of CMS Innovation Center models and resources for program overlap, visit the CMS Innovation Center website.
Find Out More
Providers and suppliers that participate in a Shared Savings Program ACO should contact their ACO for more specific information on participation in the program.
For general information on provider participation in the Shared Savings Program, refer to: