Next Generation Professional definition
Examples of Next Generation Professional in a sentence
A Next Generation Professional who is a primary care specialist as defined in Appendix B of this Agreement may not: (a) be identified as a Next Generation Participant by a different accountable care organization in this Model; (b) be an ACO participant, ACO provider/supplier or ACO professional in the MSSP; or (c) participate in another Medicare shared savings initiative, except as expressly permitted by CMS.
The ACO shall ensure that the Next Generation Professional or Preferred Provider that provided the Post-Discharge Home Visits services returns to the Beneficiary any monies collected from the Beneficiary.
A Next Generation Professional who is a primary care specialist as defined in Appendix B may not: (a) be identified as a Next Generation Participant by a different accountable care organization in the Model; (b) be an ACO participant, ACO provider/supplier or ACO professional in the Medicare Shared Savings Program; or (c) participate in another Medicare ACO model, except as expressly permitted by CMS.
CMS will administratively opt a Next Generation Beneficiary back into such claims data sharing if: (a) he or she was administratively opted out of data sharing solely due to the termination of a Next Generation Professional from the given ACO; (b) he or she is aligned to the ACO for a subsequent Performance Year; and (c) he or she does not affirmatively opt out of data sharing according to this Section VI.C.
Such steps may include program implementation assistance, education, and mentoring to the Next Generation Participant and/or the applicable Next Generation Professional.
CMS may remove a Next Generation Professional or Preferred Provider from the list of Next Generation Professionals or Preferred Providers that may participate in this Post- Discharge Home Visits Benefit Enhancement at any time if the Next Generation Professional or Preferred Provider’s participation in this Post-Discharge Home Visits Benefits Enhancement might compromise the integrity of the Model.
When necessary, the Company shall take steps to address non- compliance by Next Generation Participant or any Next Generation Professional with the requirements of this Agreement, including adherence to the Compliance Plan and evidence- based clinical guidelines.
The ACO shall ensure, through its agreement with each Next Generation Professional and Preferred Provider that will be participating in the Post-Discharge Home Visits Benefit Enhancement, that the Next Generation Professional or Preferred Provider shall require all auxiliary personnel to comply with the terms of this Agreement and Appendix.
CMS will administratively opt a Next Generation Beneficiary back into such claims data sharing if they were administratively opted out of data sharing solely due to the termination of a Next Generation Professional within the given ACO.
Next Generation Participant understands, however, that, if Next Generation Participant or any Next Generation Professional fails to adhere to the Compliance Plan, the evidence-based clinical guidelines, or the patient-centeredness processes, or is deficient in meeting the CMS quality performance standards, the Company may use progressive remedial processes and sanctions to improve compliance and performance.