Payment Integrity & Compliance

In the past 30 days, significant advancements have emerged in value-based care, notably with CMS's finalization of the mandatory Ambulatory Specialty Model set to begin January 1, 2027. This model will hold outpatient specialists accountable for managing chronic conditions, impacting payment structures based on clinician performance metrics related to quality and costs. Additionally, the upcoming ACCESS Model introduces outcome-aligned payment approaches in Original Medicare, further expanding access and potentially reshaping ACO participation dynamics as organizations prepare for its implementation amid heightened scrutiny over performance targets and payment amounts. These developments reflect a critical shift towards more accountability in chronic care management and a stronger emphasis on aligning financial incentives with patient outcomes, posing both opportunities and challenges for stakeholders navigating these evolving payment landscapes. For more details, see CMS’ ambulatory specialty payment model and ACCESS Model updates.