CMS issues final rule on ACO significant, anomalous and highly suspect billing

The Centers for Medicare & Medicaid Services Sept. 24 issued a final rule that would carve out significant, anomalous, and highly suspect (SAHS) billing from Medicare Shared Savings Program financial calculations for calendar year 2023. The final rule is part of a larger CMS strategy to address SAHS billing activity within Accountable Care Organizations’ reconciliation. Specifically, the agency also addressed this issue in the CY 2025 physician fee schedule proposed rule. The rule's changes become effective Oct. 15.
Related News Articles
Headline
The White House June 6 issued a memorandum directing the Secretary of the Department of Health and Human Services “to take appropriate action to eliminate…
Headline
The Government Accountability Office May 29 released a report recommending the Centers for Medicare & Medicaid Services target behavioral health services…
Headline
The Centers for Medicare & Medicaid Services May 21 announced it will immediately begin annual audits of all Medicare Advantage plans and work to clear a…
Headline
The Centers for Medicare & Medicaid Services May 12 released draft guidance for the third round of negotiations for the Medicare Drug Price Negotiation…
Headline
Leaders from the Centers for Medicare & Medicaid Services at the 2025 AHA Annual Membership Meeting May 5 discussed issues on the agency’s agenda in a…
Headline
The AHA April 30 released a report highlighting how hospitals and health systems continue to experience significant financial headwinds that can challenge…