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MACRA & Other Physician Payment
The Centers for Medicare and Medicaid Services (CMS) uses the Medicare Physician Fee Schedule (PFS) to determine how to reimburs
Program Integrity
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.
Inpatient Rehabilitation Facility PPS
This web page provides information and resources related to inpatient rehabilitation hospitals and units, with a focus on Medicare payment and related implementation issues.
Limited Service Providers
For decades, the Ethics in Patient Referrals Act ("Stark Law") has protected the Medicare program from the inherent conflict of interest created when physicians self-referral their patients to faci
Hospital Readmission Reduction Program
Through the Hospital Readmission Reduction Program, the Centers for Medicare & Medicaid Services penalizes hospitals for “excess” readmissions when compared to “expected” levels of readmis
Psychiatric PPS
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
Electronic Clinical Quality Measures
eCQM reporting must be based upon information that is feasible to collect in an automated fashion, generate valid and reliable results, and thereby demonstrate a benefit that outweighs the costs.
EHRs - Meaningful Use
We know hospitals use EHRs and other technology in ways that are meaningful to patients and communities.
Interoperability
Interoperability includes the exchange and use of information within a health care organization and across organizations.