Close close-icon
notification-icon

Important Alerts:

4th of July Holiday Hours

CareMount is offering the COVID-19 Vaccination to Babies and Children 6 Months of Age and Older and Booster Dose for Ages 5+, click here to learn more

COVID-19 Guidance and Testing, click here

 

Close

Direct Contract Entity (DCE)

FAQs

 

Direct Contract Entity Model Frequently Asked Questions

Some Medicare beneficiaries may have recently received a letter in the mail or from their doctor asking them to confirm their main doctor or doctor’s office. These letters are associated with a new Medicare initiative called the Direct Contract Entity (DCE) Model. Organizations participating in this initiative are called Direct Contract Entity DCEs.

For more information or for resources available to answer your questions, please refer to the end of this document.

Q1. What is this letter? What does it mean for me?

This letter explains that your doctor or the group practice where you receive care is participating in a DCE, a new program where health care providers who share a common vision of improving patient care can work together more effectively. You are receiving this letter because your health care provider thinks that you might benefit from care coordination and preventive services offered by the DCE.

For more information regarding DCEs, see the Centers for Medicare and Medicaid Services (CMS) publication Medicare and You, p. 122-123 (2021), available at https://www.medicare.gov/pubs/pdf/10050-Medicare-and-You.pdf.

Q2. What is an Direct Contract Entity (DCE)?

Direct Contract Entity, or DCEs, are groups of doctors, hospitals, and other health care professionals, who come together voluntarily to give coordinated high quality care to the Medicare patients they serve. Coordinated care may include talking with your different medical providers to manage your medications and may also include providing you with certain preventive care services. DCE services vary but can include providing transportation for doctor appointments or providing you with a list of resources in your community where you can get other services you may want or need.

Q3. Why does the letter refer to an organization I’ve never heard of?

The name of the Direct Contract Entity is the name of the entity that works with a number of different participating medical providers, such as a primary care practice, a hospital, a specialist, a pharmacy, and other Medicare-enrolled providers to provide care for patients. You may be familiar with the doctor participating in the Direct Contract Entity DCE, but not with the name of the DCE itself. If you have questions about the Direct Contract Entity DCE listed on your letter, you may call their number that is provided in the letter.

Q4. Are you trying to sell me something? What does this cost me?

No, we are not selling anything. There is no cost to you as a result of your doctor’s participation in a Direct Contract Entity DCE and no change to your Medicare benefits. Your Medicare benefits will remain the same and you will continue to have access to any Medicare participating provider.

Q5. Is Medicare changing my doctor?

No. Medicare is not changing your doctor and you can still see any doctor you choose that accepts Medicare.

Q6. Are these letters legitimate?

Yes, the letter you received from your doctor or from a Direct Contract Entity DCE is a legitimate Medicare document and part of an ongoing Medicare initiative. You can contact 1-800-MEDICARE for additional information. Also, if you have any concerns, suggestions, or comments to share, please contact the CMS Direct Contract Entity team at: DPC@cms.hhs.gov

Q7. Can I still see my specialist at another group and can I still go to my preferred hospital?

You will still have the right to receive care from any doctor or hospital that accepts Medicare. Your doctors will continue to recommend specialists and hospitals for your specific health needs. One of the goals of this program is to improve coordination of care, which DCEs are best able to do when patients receive care from a doctor or group practice associated with the DCE.

Q8. What does this mean for my care while I am in a location other than my area of residence?

You will still have the right to receive care from any doctor or hospital that accepts Medicare.

Q9. What does the Direct Contract Entity do with my health information? Who will see it?

The only information that Medicare will send to the DCE is from the bills that it received for your care in the past three years and going forward. This does not include doctors’ notes or images.

Those who are involved in your treatment will see your information to identify risks for hospital admission, to enroll you, if needed, in a care management program or to reach out to you for screenings, vaccinations, or health education. The information the DCE receives will also help it to design programs that will support the needs of all our Medicare patients. You may elect to not have your personal identifiable medical information shared with a DCE through the data opt-out process. For more information on this process, please contact 1-800-MEDICARE.

Q10. How will Medicare ensure quality of care?

As a Medicare DCE, the DCE will be required to meet robust quality standards based upon, among other measures, patient outcomes and care coordination among the provider team. DCE performance on these measures is publicly posted on the CMS website.

Q11. Where can I find out more information about DCEs and the Direct Contract Entity DCE Model?

If you have any further questions about DCEs you may ask your doctor, contact the DCE by using the phone number on the letter, contact your local State Health Insurance Assistance Program (SHIP), or call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You can also get more information online at the websites below:

You can find this information at the back of your Medicare and You 2022 Handbook as well.

Q12. Who do I contact if I suspect fraud or abuse?

Contact your local Senior Medicare Patrol (SMP) Program to report suspected Medicare fraud and abuse. There is an SMP Program in every state. The SMP Program educates and empowers people with Medicare to take an active role in detecting and preventing health care fraud and abuse. The SMP Program not only protects people with Medicare, it also helps preserve Medicare. You can also contact your local SMP Program to get personalized counseling, find out about community events in your area, or volunteer. For more information or to find your local SMP Program, visit http://www.smpresource.org/.

More Information Here:

Additional information on Annual Wellness Visits:

https://www.medicare.gov/coverage/preventive-visit-and-yearly-wellness-exams.html
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNProducts/downloads/AWV_Chart_ICN905706.pdf