CMS Innovation Model

The CMS ACCESS Program

In Home Medical Group is proud to participate in the CMS ACCESS Program, a Medicare innovation model designed to improve care coordination, behavioral health integration, and long-term outcomes for Medicare beneficiaries.

Our Service Area: Illinois, southern Wisconsin, and Indiana

What is the CMS ACCESS Program?

ACCESS (Accountable Care for Cognitive and Cardiac Care Excellence in Social Supports) is a CMS Innovation model that supports Medicare beneficiaries with complex care needs through enhanced coordination and community-based services.

Coordinated Care

A dedicated care team works with you and your doctors to make sure all your health needs are connected, with no more falling through the cracks between specialists and providers.

Behavioral Health Integration

Mental health and substance use support are built directly into your primary care experience, so your whole health is treated, not just individual conditions.

Chronic Condition Focus

Specially designed for patients managing heart disease, cognitive conditions, or other complex chronic conditions requiring ongoing coordination across care teams.

No Extra Cost to You

If you're a Medicare beneficiary, participation in ACCESS is at no additional cost. Your existing Medicare benefits apply, so you simply receive more coordinated support.

What you can expect

Patients enrolled in ACCESS-participating practices benefit from a more proactive, personalized approach to care.

01

A named care coordinator

Someone who knows your history and can help navigate appointments, referrals, and follow-ups on your behalf.

02

Proactive outreach

Your care team checks in between visits, not just when you're sick, to help manage medications, symptoms, and transitions.

03

Integrated behavioral health

Access to mental health support within the same practice, with fewer referrals, fewer barriers, and more complete care.

Departments involved at In Home Medical Group

The following In Home Medical Group departments are part of our ACCESS program participation and provide coordinated support for enrolled patients.

Physical Medicine & Rehabilitation

Our PM&R specialists focus on restoring function and improving quality of life, critical for Medicare patients managing musculoskeletal conditions, post-acute recovery, or neurological impairment.

Behavioral Health

Our Behavioral Health team provides integrated mental health services alongside primary and specialty care, reducing barriers to treatment and ensuring your emotional well-being is part of your overall care plan.

Ready to learn more or get enrolled?

If you're a Medicare beneficiary, or a referring provider or PCP interested in connecting your patients to our ACCESS program, our team is here to help. Reach out directly or visit the CMS website for full program details.

Visit CMS ACCESS Program Page

Beneficiary Cost Sharing Policy

In Home Medical Group is committed to transparency about your financial responsibility. Below is our full cost sharing policy for your reference.

1. Purpose

This policy explains how In Home Medical Group determines and collects a patient's ("beneficiary's") share of the cost for healthcare services. Our goal is to be transparent about your financial responsibility so there are no surprises after your visit.

2. Definitions

  • Copayment (Copay): A fixed dollar amount you pay for a covered service at the time of the visit (e.g., $25 for a primary care visit).
  • Coinsurance: A percentage of the allowed cost of a service that you're responsible for after your deductible is met (e.g., 20% of the allowed amount).
  • Deductible: The amount you must pay out-of-pocket for covered services before your insurance plan begins to pay.
  • Out-of-Pocket Maximum: The most you'll have to pay for covered services in a plan year; after this amount, your insurance pays 100% of covered services.
  • Allowed Amount: The maximum amount your insurance plan will pay for a covered service, as negotiated between the plan and the provider.

3. How Your Cost Share Is Determined

Your specific cost-sharing amounts depend on:

  • Your individual insurance plan and benefit design
  • Whether the service is in-network or out-of-network
  • Whether you have met your annual deductible
  • The type of service received (e.g., preventive care, specialist visit, procedure)

We recommend reviewing your insurance plan's Summary of Benefits or contacting your insurer directly for plan-specific details, as In Home Medical Group does not set your plan's benefit structure.

4. When Cost Sharing Is Collected

  • Copayments are generally collected at the time of check-in.
  • Coinsurance and deductible amounts are typically billed after your insurance has processed the claim, since the exact amount depends on how your insurer adjudicates the claim.
  • Estimated costs may be requested in advance for certain elective or scheduled procedures.

5. Good Faith Estimates

For patients who are uninsured or choose not to use insurance, In Home Medical Group will provide a Good Faith Estimate of expected charges prior to scheduled services, consistent with applicable federal and state requirements (e.g., the No Surprises Act).

6. Financial Assistance and Payment Plans

We understand that cost sharing can create financial hardship. In Home Medical Group offers:

  • Interest-free payment plans for balances over $500
  • Financial hardship / charity care applications for qualifying patients based on income and household size
  • Prompt-pay discounts where applicable and permitted by payer contracts

To request financial assistance, contact our billing office at 1-630-320-6871.

7. Disputing a Charge

If you believe your cost-sharing amount was calculated in error, you may:

  1. Request an itemized statement from our billing department
  2. Contact your insurance plan to confirm how the claim was processed
  3. Submit a billing inquiry to In Home Medical Group at 1-630-320-6871

8. Non-Discrimination

Cost-sharing policies are applied consistently to all patients regardless of race, ethnicity, national origin, religion, sex, age, disability, or health status, in accordance with applicable law.

9. Questions

For questions about your bill, insurance coverage, or this policy, please contact:

In Home Medical Group Billing Department
Phone: 1-630-320-6871

This policy is subject to change. This document is intended for general informational purposes and does not constitute a guarantee of coverage or costs, which are determined by your individual insurance plan.

In Home Medical Group participates in the CMS ACCESS model administered by the Centers for Medicare & Medicaid Services (CMS) Innovation Center. This page is intended for informational purposes for Medicare beneficiaries and referring providers. For complete program details, eligibility criteria, and official enrollment information, visit cms.gov/priorities/innovation/innovation-models/access. This page does not constitute medical or legal advice.