Centers for Medicare and Medicaid Services

workman’s compensation claims, hospitals face the challenge of only being paid the Medicare inpatient prospective payment system (IPPS) rate for hospitalizations based on Medicare severity diagnosis-related groups (MS-DRGs) rather than full amounts which are billed to insurance companies and uninsured individuals (Centers for Medicare & Medicaid Services, 2016a; Centers for Medicare & Medicaid Services, 2016b). If a Medicare patient’s hospital length of stay is longer than the MS-DRG average,…

Fraud Case Study Report Medicare fraud can cost taxpayers billions of dollars and places the health and welfare of Medicare beneficiaries at risk (CMS, 2017). Both over-coding and under-coding constitute Medicare fraud (Dillon & Hoyson, 2014). Knowingly billing for services at a level of complexity higher than services provided or documented in the file creates Medicare fraud (CMS, 2017). Knowingly submitting, or causing to be submitted, false claims or making misrepresentations of fact to…

The paper below discusses what Medicare and Medicaid are. It also talks about who is eligible for these two programs, and what they consist of. Medicare offers 4 different parts of health care. Part A, B, C, &D. These parts focus on hospital and medical insurance, as well as prescription drug coverage. Medicaid offers many different programs, such as programs for children, long term care facilities, and community and home-based patient’s. The program that they offer for children is called CHIP,…

percent of GDP in 2014 has outpaced the other sectors of the nation’s economy (Centers for Medicare and Medicare Services, 2014). In 2014, nation’s health care expenditures grew to $ 3 trillion an increase of 5.4 percent from 2013 (National health expenditure, 2014). According to Organization for Economic Co-operation and Development (2103), the government sponsored nation’s public health insurance program Medicare and Medicaid constitutes about 48 percent of national health care expenditures.…

2000 did not significantly increase (Centers for Disease Control and Prevention, 2004) The inpatient discharges for Medicare beneficiaries declined 6 percent from 2004 to 2010 (Grube, M., Kaufman, K., York, R., 2013). The errors in prediction of a decrease in hospitalization are multiple. The advancements in preventative care in control of diabetes, hypertension, hyperlipidemia, and smoking have significantly reduced the prevalence of cardiovascular…

Healthcare Data Set OASIS-C OASIS (Outcome and Assessment Information Set) is officially the data collection tool used by Medicare to ensure standard quality care is being provided by home health agencies across the U.S.(Quan, 2009). This group of data measurements has been developed, tested and refined over the last ten years to measure outcome for home health care and measures patient outcome for outcome-based quality improvement (OBQI). The model of standardization for OASIS is adopted from…

affordable health care (U.S. Department of Health & Human Services, n.d.). The meaningful use is defined as the use of certified Electronic Health Recording (EHR) technology in a meaningful manner that safely exchanges, electronic health information to improve quality and efficiency of care (Centers for Disease control and Prevention [CDC], 2015). The goals of the adoption of health information technology…

organizations provide different services that impact various populations, however there are only five that will be examined in this paper. The organizations being examined are all under the umbrella of the U.S. Department of Health and Human Services, they are; the Center for Disease Control (CDC), National Institute of Health (NIH), the U.S. Food and Drug Administration (FDA), Health Resources and Services Administration…

copayments, and coinsurance as applied to in-network services (Kongstvedt, 2013). This type of plan allows, the mentioned individual, to…

The Hospital Value-Based Purchasing (VBP) program is an initiative by the Centers for Medicare and Medicaid Services (CMS) that rewards acute-care hospitals with incentive payments for the quality of care they give to people with Medicare (Centers for Medicare and Medicaid Services, 2015). CMS rewards acute care hospitals based on the quality of care they provide, on how closely best clinical practices are followed, and on how well they enhance the patients’ experience of care. The hospital VBP…