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.

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.

• Inpatient Psychiatric Facility PPS
• Hospice
• Skilled Nursing Facility PPS
• Inpatient Rehabilitation Facility PPS
• Acute Inpatient and Long-Term Care Hospital PPS
• End-Stage Renal Disease PPS
• Home Health PPS
• Hospital Outpatient PPS
• Ambulatory Surgical Centers

MHA Quality Reporting Guides

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

External Sources

• Medicare Administrative Contractor Wisconsin Physicians Service Government Health Administrators
• Centers for Medicare & Medicaid Services
  • Hospital Center
  • Critical Access Hospital Center
• Medicare Payment Advisory Commission
  • At this site, users can search for Medicare information in the “Documents” section.

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.