AHA and Partners Urge CMS to Shield ACOs and MIPS Clinicians From Skin Substitute Billing Risks

A coalition including the American Hospital Association (AHA) has called on the Centers for Medicare & Medicaid Services (CMS) to protect accountable care organizations (ACOs) and clinicians eligible for the Merit-based Incentive Payment System (MIPS) from financial liability tied to increased billing for skin substitutes. Though some spending is justified by wound care needs, a significant portion is linked to inefficient or fraudulent billing practices, raising concerns over cost accuracy. Current trend adjustments in Medicare programs like the Shared Savings Program, Realizing Equity Model, and Comprehensive Kidney Care Contracting Model are insufficient to offset these billing increases, potentially causing undue financial penalties for providers in these models.