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ACO Physician Exclusivity: Principles and Alternatives


Executive Summary - March 2014

ACO Physician Exclusivity: Principles and Alternatives
Authored by Rick L. Hindmand (McDonald Hopkins LLC, Chicago, IL), and edited by Christi J. Braun (Mintz Levin Cohn Ferris Glovsky and Popeo PC, Washington, DC), and Jan E. Murray (Foley & Lardner LLP, Boston, MA) 

The Medicare Shared Savings Program (MSSP) physician exclusivity restriction prevents physician practices from being included as participants in more than one MSSP accountable care organization (ACO) if they bill Medicare under any of the Healthcare Common Procedure Coding System codes listed in the expansive MSSP definition of “primary care services,” which includes evaluation and management codes commonly billed not only by primary care physicians but also by physicians in various specialties.

This Executive Summary examines physician exclusivity principles and some related complications for physician practices and ACOs, as well as several alternative approaches to affiliate with multiple ACOs.

We would like to thank the author and editors for sharing their expertise with their colleagues.

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