Medicare coverage is tied to eligibility for Social Security or Railroad Retirement benefits. In 2015, there were almost 56 million people enrolled nationwide.
The program includes:
Hospital Insurance - Also known as "Part A," Medicare hospital insurance helps cover inpatient care in ...
What Is the Inpatient Prospective Payment System (IPPS)?
One in every five Medicare beneficiaries is hospitalized one or more times each year. Of the approximately $300 billion dollars spent on the Medicare program each year, almost $100 billion is spent on inpatient services.
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The Centers for Medicare & Medicaid Services (CMS) July 13 released its calendar year (CY) 2024 outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) proposed rule that would increase OPPS rates by a net 2.8% in CY 2024 compared to CY 2023. The rule al...
The Centers for Medicare and Medicaid Services (CMS) uses the Medicare Physician Fee Schedule (PFS) to determine how to reimburse physicians for their services. Under the PFS, Medicare considers various elements including the work the physician put in, the expenses incurred in provid...
This web page provides information and resources related to inpatient rehabilitation hospitals and units, with a focus on Medicare payment and related implementation issues.
Visitors to this site may also be interested in learning more about the resources and services of the AHA Consti...
AT A GLANCE
On June 30, the Centers for Medicare & Medicaid Services (CMS) issued its calendar year (CY) 2024 proposed rule for the home health (HH) prospective payment system (PPS). Comments are due Aug. 29, and a final rule is expected around Nov. 1. New policies will gener...
340B Drug Pricing Program at a Glance
For more than 30 years, the 340B Drug Pricing Program has provided financial help to hospitals serving vulnerable communities to manage rising prescription drug costs.
Section 340B of the Public Health Service Act requires pharmaceutical manuf...
The Hospital-Acquired Condition Reduction Program ties performance on patient safety issues such as infections, bed sores and post-operative blood clots to payment. Under the program, the Centers for Medicare & Medicaid Services penalizes the lowest performing 25% of all hospitals e...
Through the Hospital Readmission Reduction Program, the Centers for Medicare & Medicaid Services penalizes hospitals for “excess” readmissions when compared to “expected” levels of readmissions. Since the program began on Oct. 1, 2012, hospitals have experienced nearly $2.5 billion ...
The Hospital Value-Based Purchasing Program seeks to improve patient safety and experience by basing Medicare payments on the quality of care provided, rather than on the quantity of services performed. Hospital VBP affects payment for inpatient stays in more than 3,000 hospitals across...
Traditionally, Medicare has made separate payments to providers for each of the individual services they furnish to beneficiaries for a certain illness or course of treatment. However, policymakers and providers have become increasingly concerned that this approach may result in fragmen...
What Are Accountable Care Organizations (ACOs)?
Accountable Care Organizations are groups of clinicians, hospitals and other health care providers who come together voluntarily to give coordinated high-quality care a designated group of patients. While some private plans have contra...
According to the Agency for Healthcare Research and Quality, the patient-centered medical home encompasses:
1. Comprehensive care that meets the large majority of each patient’s physical and mental health care needs, including prevention and wellness, acute care, and chronic care.
2. ...
In recent years, the Centers for Medicare & Medicaid Services has drastically increased the number of program integrity auditors that review hospital claims to identify improper payments. These audit contractors include recovery audit contractors (RACs) and Medicare administrative c...
Medicare pays for these services through the IPF prospective payment system, which uses pre-determined rates based primarily on the patient’s condition (age, diagnosis, comorbidities) and length of stay, and the location of the IPF. Medicare also provides additional payment for IPFs tha...
This site names each program, its focus, the types of financing available, and eligibility requirements. Links to each program's website and other capital financing information resources are provided for more information.
Preliminary Background on Federal Capital Programs
P...