CMS Finalizes ACO Rule to Address Anomalous Spending in CY23

The Centers for Medicare & Medicaid Services (CMS) on Sept. 27 published a final rule to address the impacts of significant, anomalous, and highly suspect billing activity in calendar year (CY) 2023 for accountable care organizations (ACOs) participating in the Medicare Shared Savings Program. This rule responds to prior advocacy from invested parties emphasizing the need to hold ACOs harmless for anomalous catheter spending that, if left unaddressed, would prevent otherwise successful ACOs from achieving shared savings in the program [refer to Washington Highlights, Aug. 2]. Specifically, it sets policies for assessing financial performance in 2023, outlining how the agency will account for the anomalous spending when establishing financial benchmarks for 2024, 2025, and 2026 in the program.