Source: US Department of Health and Human Services
On September 24, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the final rule entitled, “Medicare Program: Mitigating the Impact of Significant, Anomalous, and Highly Suspect Billing Activity on Medicare Shared Savings Program Financial Calculations in Calendar Year 2023” (CMS-1799-F). This final rule is part of a larger strategy to address significant, anomalous, and highly suspect (SAHS) billing activity within Accountable Care Organizations (ACOs) reconciliation. A proposal in the calendar year (CY) 2025 Physician Fee Schedule (PFS) proposed rule addresses SAHS billing activity for CY 2024 onwards. This fact sheet summarizes the Medicare Shared Savings Program (Shared Savings Program) policies that are included in this final rule.