(ACO) regulations - American Society of Anesthesiologists

CMS-1345-P 321
● Failure to completely and accurately report or failure to make timely
corrections.
● Material noncompliance, or a pattern of noncompliance, with public reporting
and other CMS reporting requirements.
● Limiting or restricting internally compiled beneficiary summary of care or
medical records from providers and suppliers both within and outside of the ACO, to the
extent permitted by law (for example, not sharing beneficiary medical records with
providers or suppliers not participating in the ACO from whom the beneficiary chooses
to receive care).
● Failure to offer beneficiaries the option to opt out of sharing claims
information.
● Improper use or disclosure of claims information received from us in violation
of the HIPAA Privacy Rule, Medicare Part D Data Rule, Privacy Act, the data use
agreement, or other applicable laws or regulations.
● Violation of physician self-referral prohibition, civil monetary penalty laws,
anti-kickback statute, other antifraud laws, antitrust laws, or other applicable Medicare
laws, rules, or regulations that are relevant to ACO operations.
● Submission to us of false, inaccurate, or incomplete data and or information,
including but not limited to, information provided in the Shared Savings Program
application, quality data, financial data, and information regarding the distribution of
shared savings.
● Failure to submit payment due to us in a timely manner.