Medicare Platform’s Advance Payment to Providers, Briefly Explained

Medicare Platform has developed an innovative business model focused on utilizing proprietary data analytics and a compliance infrastructure to help ACOs and their participating providers achieve better health care outcomes and improved financial performance. In some instances, Medicare Platform’s business model may include offering prospective providers an advanced payment on behalf of its client ACOs. Advance pre-participation payments are conditioned on the potential ACO participant executing an ACO participation agreement. The payment is one step in the process of Medicare Platform and the potential participant’s intent to work together toward formation of an MSSP-eligible ACO. Inclusion in the ACO is contingent on the potential participant meeting all applicable requirements for ACO participation.

Pre-participation payments have been approved by CMS as a pathway to protect bona fide ACO investment, start-up, operating, and other expenses, addressing stakeholder’s concerns that restrictions in health care laws could potentially impede development of innovative integrated-care arrangements.

The investments are used by Medicare Platform’s client ACOs and participating providers to build infrastructure and care coordination mechanisms, hire new staff, and create incentives for performance-based payment systems. The uses of pre-participation funds are limited to:

• Administrative work support, technology, prevention, screening, and care coordination efforts related to MSSP ACO activities;
• Technology platforms for SDOH assessments, preventive care, care coordination, HIE, EHR integration, proactive care or chronic care management; or
• An additional 30% above the Medicare Fee Schedule for E/M codes billed by the potential participant, to reimburse providers for additional time spent on care coordination and improved delivery;

The payment is not a “signing bonus”. It is not based on the value or volume of referrals or other business generated between the parties or for any party. It is an investment in a start-up arrangement, often necessary to support ACOs and participants in the ACO’s early stages.

Medicare Platform LLC operates as a market-enabling platform, integrating proprietary datasets with advanced analytics to improve clinical outcomes, aggregate clinical data, identify cost reduction opportunities, and administer shared savings programs – giving ACOs and providers the tools they need to improve patient outcomes and control costs. In addition to its ACO enablement functions, Medicare Platform supports improvements in quality care and patient outcomes by providing the operational and analytic tools required to manage high-needs and lower-complexity beneficiaries under structured value-based arrangements, allowing physicians to spend time doing what they are trained to do – provide the highest quality care to their patients.

Nothing in this post constitutes financial or legal advice. No specific financial outcome is guaranteed or implied. References to shared savings potential are illustrative. Actual results will vary by ACO and provider.