Hospitals that serve as Medicare providers must adhere to various rules and regulations for patient care and reimbursement. The following offer guidance to hospitals to ensure their compliance with Medicare.

  • Reimbursement
  • Regulations
  • RAC

Medicare utilizes several mechanisms to pay for services provided to their 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 an 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 effect 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.

Presentation have been updated for 2019.


MHA Issue Briefs Examine 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.



Provider Type

At this site, users can search for Medicare information in the "Documents" section.

MHA has developed resources on self-assessment checklists and Medicare Conditions of Participation for hospitals to use in complying with Medicare regulations. MHA also has quality resource guides for acute care hospitals, critical access hospitals and specialty services (located under the resources tab on the Quality Initiatives webpage). 

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. The following is a listing of resources available about the RAC Program.

CMS Resources

Cotiviti Resources

American Hospital Association Resources

Missouri Hospital Association Advocacy Materials – latest white paper shared with the U.S. Congressional Delegation