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Medicare

Hospitals that serve as Medicare providers must adhere to various rules and regulations for patient care and reimbursement.

The following offers guidance to hospitals to ensure their compliance with Medicare.

Reimbursement

Medicare utilizes several mechanisms to pay for services provided to its beneficiaries. Throughout the last few years, the Centers for Medicare & Medicaid Services has begun tying payments to certain quality metrics. The following series of on-demand webinars serve as an educational instrument that will help the listener gain a high level of understanding about the programs, as well as have the opportunity to listen and see simulations about how the pay-for-performance calculations affect payment. Each session is designed to be short in nature, typically lasting 10 minutes. The exception is the value-based purchasing 201 session, which is about 30 minutes.

Listen to the Medicare Reimbursement Series

Regulations

MHA Issue Briefs — Final PPS Regulations

The Centers for Medicare & Medicaid Services has issued final versions of its regulatory changes for Medicare’s fiscal year 2019 PPS. MHA has published issue briefs on the following rules.

MHA Quality Reporting Guides

MHA created quality reporting guides for acute care hospitals, critical access hospitals and specialty services.

External Sources

Recovery Audit Contractor Program

The Medicare Recovery Audit Contractor Program was established by the Centers for Medicare & Medicaid Services to correct Medicare fee-for-service payments made to providers. CMS awarded new FFS RAC contracts as of Oct. 31, 2016. The RAC covering Region 2, which includes the entire state of Missouri, is now Cotiviti, LLC.

Contact An Expert

Andrew Wheeler

Andrew Wheeler

Vice President of Federal Finance
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