(a) * * * (2) * * * ( (iii) In the case of an ACO that has selected preliminary prospective assignment with retrospective reconciliation, by the ACO or ACO participant providing each beneficiary who received at least one primary care service during the assignment window or applicable expanded window for assignment (as defined in 425.20) from a physician who is an ACO professional in the ACO and who is a primary care physician as defined under 425.20 or who has one of the primary specialty designations included in 425.402(c), a FQHC or RHC that is part of the ACO, or an ACO professional in the ACO whom the beneficiary designated as responsible for coordinating their overall care under 425.402(e) with a standardized written notice at least once during an agreement period in the form and manner specified by CMS
With regard to age, the burden of most substance use subtypes increased with age
The clinical value of the intervention and its contribution to overall patient health outcomes should be weighed alongside the direct reimbursement amount
Thus, by imputing zero savings or losses for a BY corresponding to a performance year that was not financially reconciled in the calculation of the prepaid shared savings multiplier, we are reducing the probability of overpredicting the financial performance of the ACO for a given performance year within the current agreement period and, in turn, the probability of distributing excessive prepaid shared savings
As we ordinarily do, we are proposing to base the PFS valuation for APCM codes on the resources involved in furnishing the typical case of the service which may not necessarily reflect the actual resources involved in furnishing every individual service
