An assignable beneficiary is a Medicare fee-for-service beneficiary who receives at least one primary care service with a date of service during a specified 12-month assignment window from a Medicare-enrolled physician who is a primary care physician or who has one of the specialty designations. A beneficiary is considered to be assignable to a particular ACO if he or she has a primary care service with a qualified physician at the ACO. Qualified physicians include primary care physicians, or physicians on an FQHC (Federally Qualified Health Center)/RHC (Rural Health Clinic) attestation list.
Assigned beneficiary person-year counts are based on certified ACO (Accountable Care Organization) participant lists for the performance year associated with the file year and based on the assignment methodology and definition of dual eligible beneficiaries in effect for that performance year.
If the beneficiary has at least one primary care service furnished by a primary care physician or a non-physician practitioner (nurse practitioner, physician assistant or clinical nurse specialist) or an ACO professional at an FQHC/RHC in the participating ACO, and more primary care services (measured by Medicare allowed charges) furnished by primary care physicians or non-physician practitioners or ACO professionals at an FQHC/RHC in the participating ACO than furnished by primary care physicians or non-physician practitioners or ACO professionals at an FQHC/RHC in any other ACO, or non-ACO individual or group TIN (Tax Identification Number), then the beneficiary is assigned to the participating ACO.