A payment tied to an outcome is arithmetic your system has never done
Organizations looking at the CMS ACCESS Model are usually asking one operational question: can our systems compute what an arrangement like this should pay, and show the working. Attergo prices arrangements outside fee for service through the same engine it prices a fee schedule with, and holds the measures behind them as governed definitions.
Fee-for-service systems compute expectations by looking up a line
Ask a billing system what a claim should pay and it finds the code on a schedule. Change the unit of payment to an episode, a period or an outcome and that machinery does not degrade gracefully. It multiplies a single payment by the line count and returns a confident wrong number. A variance built on that is arithmetic error, and a variance nobody trusts is never worked.
The mechanism behind it.
Eight payment bases, one engine
Fee schedule, percent of charge, percent of fee schedule, per diem, case rate, DRG weighted, acquisition plus and capitated run through the same code path. An arrangement outside fee for service is configuration rather than a second system to keep in step with the first.
A period payment pays once
An arrangement that pays for an episode or a period produces one expectation for that episode, not one per line. The unit of payment is a property of the contract term rather than an assumption buried in code.
Measures defined once, versioned, with lineage
Whatever measures an arrangement is settled against are held with their definition, their lineage and a freshness stamp. The figure you look at and the figure you submit come from the same definition, and a change to it carries a version.
Every figure traces back to the events behind it
A number that cannot be taken apart is a number you will be asked to take apart. Evidence links bind a reported figure to the records that produced it, so the question is answered by a query rather than by an investigation.
Read the rules from the body that wrote them.
This describes software, not a program. Eligibility, terms, obligations and dates are set and published by the administering body, they change, and they are the version that governs you. Attergo administers no program named here, determines no eligibility and files nothing with an agency on your behalf. No approval, endorsement, participation or affiliation is claimed or implied.