PURPOSE: The purpose of this guidance is to protect the rights of the Beneficiary’s right to choose of data sharing.

DEFINITIONS: Term Definition

  • ACO Participant:  An entity identified by a Medicare-enrolled billing TIN through which one or more ACO providers/suppliers bill Medicare, that alone or together with one or more other ACO participants compose an ACO, and that is included on the list of ACO participants that is required under 42 C.F.R. § 425.118.
  • ACO Provider/Supplier:  An individual or entity that:  (1) is a provider or supplier under Medicare regulations; (2) is enrolled in Medicare; (3) bills for items and services furnished to Medicare fee-for-service beneficiaries during the agreement period under a Medicare billing number assigned to the TIN of an ACO participant; and (4) is included on the list of ACO providers/suppliers that is required under 42 C.F.R. § 425.118. Beneficiary Individual who is enrolled in Medicare.

POLICY: The ACO shall provide Beneficiaries who inquire about and wish to modify their preferences regarding claims data sharing for care coordination and quality improvement purposes with information about how to modify their data sharing preferences via 1-800-MEDICARE. Even if a Beneficiary has elected to decline claims data sharing, CMS may still engage in certain limited data sharing for quality improvement purposes.

PROCEDURE: If a Beneficiary inquiries about or wishes to modify their preferences regarding claims data sharing for care coordination and quality improvement purposes should:

  1. Provide the CMS number, 1-800-MEDICARE, to the Beneficiary.
  2. The ACO shall allow Beneficiaries to reverse a data sharing preference at any time by calling 1-800-MEDICARE.
  3. CMS will maintain the data sharing preferences of Beneficiaries who elect to decline data sharing.