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Improve Your Patient Attribution Rates and Your ACO Performance

Jon-Michial Carter
Written by Jon-Michial Carter

Patient attribution (or beneficiary attribution), the process of assigning Medicare patients to a provider or practice that assumes responsibility for their total cost of care, plays an essential role in value-based care. Most value-based care programs pay providers based on lowered cost-of-care per patient and improved performance on quality measures, like patient outcomes. 

Many value-based care programs are run by Accountable Care Organizations (ACOs). Providers often belong to an ACO that analyzes the quality of care Medicare patients receive and shares payments with providers accordingly. That means when Medicare patients are correctly attributed to your ACO and you provide excellent, cost-effective care to those patients, you’ll receive additional funds. 

Medicare doesn’t provide extensive detail about how patients are attributed to a specific practice or ACO. But we know that preventative care services, like Annual Wellness Visits and Chronic Care Management, play a large role. 

Adding AWVs and CCM to your practice significantly increases the probability that patients are attributed to you, so you’re fairly reimbursed for the care you provide

Value-Based Care and ACOs

Value-based care has transformed how Medicare pays providers and practices. In the past, providers relied solely on a fee-for-service (FFS) model, where they were paid every time they performed a service for a Medicare patient.

However, the FFS model focuses more on volume of services and does not necessarily encourage providers to keep patients healthy. As the movement towards value-based care has grown, the Centers for Medicare & Medicaid Services (CMS) decided to emphasize value-based payment models: models that reward providers for offering high-quality care with positive patient outcomes. 

To make value-based care a reality, CMS gave healthcare organizations the option to form Accountable Care Organizations. ACOs are groups of providers, practices, and health systems that come together to give coordinated care to a designated group of patients. 

If an ACO performs well on quality measures, like patient outcomes, and lowers the cost of care per patient, that ACO can share in the savings they’ve generated for Medicare. 

But to know whether an ACO has truly provided strong, cost-effective patient care, CMS needs to know which patients received care from a provider within the ACO. This is why patient attribution is so important. 

How Patient Attribution Affects ACOs 

During patient attribution, a patient is assigned to a provider or a healthcare practice. Some providers have their own Taxpayer Identification Number (TIN) that patients are assigned to, while others belong to a group practice with a shared TIN. 

Whether you’re a solo practitioner or part of a practice, you need to have Medicare Part B patients attributed to you for your care to count toward the payment model. 

When your ACO looks at your value-based care performance, they’ll examine your group of attributed patients. If those patients received high-quality, cost-effective care, your practice will receive a pre-defined portion of the savings your ACO generated from Medicare. 

Attribution and Different ACO Models

Different value-based care models use different forms of attribution. One of the most popular forms of value-based care is the Medicare Shared Savings Program. MSSP still provides fee-for-service payments. But the program also looks at the cost of care and outcomes for attributed patients.

MSSP primarily assigns patients to an ACO using a two-step process to evaluate encounter data. 

  1. CMS looks at the number of primary and preventative care visits. The provider who has the most encounters with the patient–the “plurality of visits”--is heavily weighted toward receiving the attribution.
  2. If the patient hasn’t visited a primary care provider, CMS looks at which specialists provided the plurality of preventative care services to the patient. 

For MSSP, it’s evident that CCM and AWV weigh heavily in the attribution formula, because CCM contributes monthly to the plurality of visits and AWVs are primary care services. But CMS also frequently experiments with other payment models, like the ACO Reach Model–and CCM and AWVs can help with attribution here too! 

Patient Attribution Under Other ACO Models

Some Accountable Care Organizations choose to join other Medicare programs, like ACO Reach and Primary Care First, as well as specialty-specific models like the Kidney Care Choices (KCC) Model.

There are different methods of patient attribution for different ACOs, but the CMS Alliance to Modernize Healthcare summarizes the most common ones as:

  • Asking patients to self-report their physician
  • Looking at the history of claims or encounters with a primary care provider
  • Looking at the history of claims or encounters with a specialist

If you want patients to self-report you as their physician, the most effective way is to provide compassionate, whole-person care. You can incorporate preventative care, like Annual Wellness Visits or Chronic Care Management check-ins, into this mission.

Claims or encounters are most often tracked with Evaluation & Management (E&M) codes. When deciding how to attribute a patient, ACOs frequently prioritize the volume of primary-care codes, followed by specialist codes. They also look at the plurality of care–which physicians provided the most primary care or other E&M services. 

If your practice belongs to an ACO that relies on claims, Chronic Care Management and Annual Wellness Visits will keep your patients healthier, while growing the number of patients attributed to you. 

How CCM and AWVs Contribute to Patient Attribution 

Chronic Care Management services and Annual Wellness Visits count as encounters for patient attribution. CCM encounters are important for attribution because of their frequency, while AWVs are powerful because they count as preventative care encounters. 

CCM and Patient Attribution

If a patient is enrolled in CCM, they will receive a CCM encounter every month–a total of 12 encounters per year! CCM falls under CPT codes like:

  • 99487
  • 99489
  • 99490
  • 99491
  • 99439
  • 99437

If an ACO sees that your practice has billed these codes for a patient 12 times in a calendar year, they’ll know that you’ve provided the plurality of the patient’s care and attribute the patient to you. (If you’d like to learn more about the different types of CCM codes, check out our guide!

AWV and Patient Attribution

Annual Wellness Visits count as primary care visits for Medicare–and Medicare values primary care visits over other types of visits. AWVs fall under CPT codes like:

  • G0438
  • G0439
  • G0468 (FQHC only) 

For more details on each of these codes, check out our AWV billing codes summary!

AWVs are also patient-friendly–they don’t come with a copay and can improve outcomes by encouraging vaccinations or cancer screenings.

But patients can only receive an Annual Wellness Visit once per year. If you perform an AWV for a patient who’s already had one, you won’t be reimbursed by Medicare or have that patient attributed to you. This is why many practices employ software that automatically checks on AWV eligibility in real-time for Medicare patients.

For eligible patients, Annual Wellness Visits are a powerful tool that can identify gaps in care while growing your practice’s beneficiary attribution.

Conquering Patient Attribution

Because different ACO models use different patient attribution models, it’s difficult to guarantee that a patient you care for will be attributed to your practice. Increasing your patient attribution rate is a vital component of ensuring your practice is paid fairly.

Annual Wellness Visits and a Chronic Care Management program can help. When patients receive an annual preventative visit or monthly check-ins from your practice, their chances of being attributed to you increase dramatically. 

AWV and CCM can help you increase revenue for your practice and show impressive patient numbers to your ACO–all while ensuring your patients receive preventative care more often. 
If you’d like to learn more about starting a Chronic Care Management program, check out our guide to frequently asked questions about CCM. And if you’re more interested in AWV, we offer a detailed breakdown of the components involved in an AWV for any practice to use.

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