Entities eligible to form an accountable care organization

Under the proposed rule, an ACO may include the following types of groups of providers and suppliers of Medicare-covered services: (1) ACO professionals (i.e., physicians and hospitals meeting the statutory definition) in group practice arrangements; (2) Networks of individual practices of ACO professionals; (3) Partnerships or joint ventures arrangements between hospitals and ACO professionals; (4) Hospitals employing ACO professionals; and (5) critical access hospitals. In addition, the Secretary of Health and Human Services (the Secretary) may, by rule, further expand the eligibility to participate to include additional Medicare enrolled entities such as federally qualified health centers (FQHCs) and rural health clinics (RHCs). In the interim, CMS has proposed to provide an incentive for ACOs to include RHCs and FQHCs by allowing ACOS that include such entities to receive a higher percentage of any shared savings.

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.