CMS Direct Contracting Fact Sheet: What You Need to Know
The Centers for Medicare and Medicaid Services (CMS) Direct Contracting program is a new payment model that aims to promote quality, value, and efficiency in healthcare. This program is designed to encourage providers to deliver high-quality care while also reducing costs for patients and the healthcare system as a whole.
If you`re a healthcare provider or organization, it`s important to understand the basics of the Direct Contracting program. Here`s what you need to know.
What is the CMS Direct Contracting Program?
The CMS Direct Contracting program is a payment model that incentivizes healthcare providers to deliver high-quality care at a lower cost. This program is part of the CMS Innovation Center and is designed to complement the existing Medicare fee-for-service program.
Under the Direct Contracting program, participating providers will be responsible for delivering comprehensive, coordinated care to Medicare beneficiaries. Providers will receive a fixed monthly payment per beneficiary to cover all Medicare Part A and Part B services. This payment will be adjusted based on the health status and medical needs of each beneficiary.
Providers must meet certain quality standards in order to participate in the Direct Contracting program. These standards include measures of patient experience, clinical quality, and population health.
What are the Benefits of Participating in the CMS Direct Contracting Program?
Participating in the CMS Direct Contracting program has several benefits for providers. Some of the key benefits include:
1. Financial stability: The fixed monthly payment per beneficiary provides financial stability for providers, as they can plan and budget for their services.
2. Reduced administrative burden: Providers will have fewer administrative tasks to complete under the Direct Contracting program, as they will be responsible for all Medicare Part A and Part B services.
3. Improved patient outcomes: The comprehensive, coordinated care delivered under the Direct Contracting program is designed to improve patient outcomes and reduce hospital readmissions.
4. Increased flexibility: Providers will have greater flexibility in how they deliver care under the Direct Contracting program, as they will not be limited by Medicare fee-for-service rules.
How to Participate in the CMS Direct Contracting Program?
To participate in the CMS Direct Contracting program, healthcare providers must submit a letter of interest to CMS. Providers must meet certain eligibility requirements, including:
1. Being a Medicare-certified provider or organization.
2. Having experience delivering primary care services to Medicare beneficiaries.
3. Meeting certain financial and operational requirements.
4. Having a commitment to delivering high-quality care and improving patient outcomes.
Providers can participate in one of two Direct Contracting models: the Global model or the Professional model. The Global model is designed for larger organizations with experience managing risk, while the Professional model is designed for smaller organizations or groups of providers.
Conclusion
The CMS Direct Contracting program is an innovative new payment model that aims to promote quality, value, and efficiency in healthcare. Participating providers will be responsible for delivering comprehensive, coordinated care to Medicare beneficiaries while receiving a fixed monthly payment per beneficiary. This program offers several benefits for providers, including financial stability, reduced administrative burden, improved patient outcomes, and increased flexibility. If you`re a healthcare provider interested in participating in the Direct Contracting program, be sure to research the eligibility requirements and submit a letter of interest to CMS.